Better Health Care for the Poor

December 19, 1991

Saving $24 million in the state's deep-in-debt Medicaid program is no small feat. But saving $24 million while simultaneously providing the state's poor with greatly enhanced health care is an even bigger achievement. Yet that is exactly what health secretary Nelson J. Sabatini intends to do over the next six months.

The idea behind this program, dubbed Maryland Access to Care (MAC), is to steer Medicaid recipients away from costly emergency rooms and toward doctors' offices or clinics for medical treatment. Not only is this a cheaper method (an emergency room visit is three times more expensive than visiting a doctor's office) but patients will be able to establish long-term relationships with their doctors, which could lead to more preventive medicine and better health care for the poor.

For instance, Mr. Sabatini expects that by giving Medicaid recipients their own doctors there will be a 10 percent increase in children receiving immunizations and a 10 percent increase in poor women who have Pap smears and mammograms regularly. That could reduce the number of children hospitalized with severe illnesses and cut down on the state's high level of breast cancer and cervical cancer cases.

By mid-summer, the state predicts 320,000 clients will be signed up with a physician, nurse practitioner or a clinic. Some 1,500 health-care providers have agreed to participate in the program and to offer 24-hour, everyday on-call care. Part of their incentive is a 50 percent hike in the Medicaid fees for an office visit.

That will be money well spent by the state. It will improve the health of the state's poor, reduce the number of hospitalizations, thin waiting lines at emergency rooms and cut overall Medicaid expenditures. The MAC program is a step in the right direction. Along with the Schaefer administration's welfare changes aimed at pressing recipients to get regular medical check-ups for their children, MAC moves Maryland into the forefront of social reforms to ensure that the poor receive better treatment at a greatly reduced cost to the state.

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