WATCH FOR political fireworks now that the state of Maryland is getting serious about the shrinking demand for hospital beds across the state. The state is setting up procedures to close some hospitals down. But, not unlike school closings, the shutting down of hospitals is an emotionally charged issue even when people accept the hard fiscal reasons for it. It matters greatly how it is done.
What Maryland is setting out to do -- an approach so far unmatched in any other state -- may be tough to carry out. But the benefits in patient care and in cost containment could be substantial. The hope is that a sensible public response could bring an orderly contraction of hospital beds and a reduction in hospitalization costs.
It's important to understand that the question isn't whether some hospitals are going to close in Maryland: economics and changes in health care will make that happen regardless. The question is whether mergers, closings and reductions in beds will be the result of free-market profit-motive pressures alone, or of a measure of orderly planning that can mean fair access to necessary health services no matter where you live in the state.
Maryland is trying to plan. A study of underused hospitals, prepared by Booz-Allen & Hamilton, the consulting firm for the state health resources planning commission, was released this week. The danger is that it will be misinterpreted as a "hit list." In fact, it is simply an inventory of the state's surplus of beds, with options for relief. Maryland's hospitals on the average are 66 percent full, a rate about the same as the national average. The object is to get rid of this one-third excess capacity by 1988. The next step is for localities to study this report and to try to come up with voluntary proposals for reductions.
Public hearings are scheduled for next month. Then, by Oct. 1, the state commission is obligated to adopt a hospital capacity plan. This would be the guide for decisions on state certificates of need -- these are the basis for permissions for capital expenditures and reviews of rates. The commission also has the authority to recommend to the state health secretary those hospitals that it believes should be closed. Hospitals that choose to downgrade voluntarily may find the licensing speedier and friendlier than those that lag.
It took leadership to come up with this approach, and Gov. Harry Hughes and the state legislature deserve credit and support for launching Maryland on an important effort to keep top-flight health care within reach, both financially and logistically, of every resident of the state.