Md. health secretary seeks alternatives to nursing homes Traditional care too costly, he says

April 16, 1993|By Sherry Joe | Sherry Joe,Staff Writer

Traditional nursing homes are too costly, and less expensive options must be created to provide health care to all, Nelson J. Sabatini, Maryland's secretary of health, said yesterday.

"We have to find ways to deal with the medical needs of the elderly in a different way," said Mr. Sabatini, who spoke at a meeting of the Howard County Chamber of Commerce.

Mr. Sabatini, who heads the Maryland Department of Health and Mental Hygiene, said elderly and severely disabled Medicaid patients are responsible for most of the $2 billion spent on public health insurance in Maryland. Of 475,000 Medicaid recipients last year, 910 people -- mostly elderly and severely disabled patients -- received $143 million in treatment, he said.

"There's got to be another way," Mr. Sabatini told the 150-member audience at the Columbia Inn.

He said less expensive treatment is needed for elderly people.

"We're spending the majority of health care on very, very sick people in very expensive settings," Mr. Sabatini said.

With less expensive alternatives to the traditional "$30,000-a-year nursing home," more money could be used to provide health care to the uninsured, he said.

"The access question is not that hard to deal with," he said.

He also urged flexibility, so patients who need only minimal care are not forced to receive more help than they need.

"We need to start helping people as individuals and not as bureaucratic systems," said Mr. Sabatini. He told a story of a mentally retarded boy who was placed in an $80,000-a-year state institution but who needs only about $25,000 a year in care.

He also dispelled stereotypes that Medicaid patients are poor inner-city residents. Instead, he said, most of the expensive users are former members of the middle class who have exhausted their insurance benefits and are forced to seek help from Medicaid.

"Most of the people on Medicaid costing big money are those recently attached to the middle class," Mr. Sabatini said.

The traditional nursing home patient, he said, is "an elderly white female who has lived in and been part of the middle class and at the end of 18 months has exhausted her insurance benefits. The severely disabled also quickly exhaust the benefits in their insurance and come into the state system."

Mr. Sabatini praised Maryland's new health care law that is intended to make insurance more available to employees of small companies.

"Maryland's health care reform will be a model for the nation," he said. "I think our bill has some exciting prospects."

He called attention to a portion of the law that calls for a new commission that will have the power to limit doctor's fees if voluntary cost-control strategies fail.

Mr. Sabatini said about 30 percent to 40 percent of medical costs are for administration and overhead. He said the nation must consider rationing health care if it wants to provide access to the uninsured.

"We've got to be honestly ready to consider rationing . . . but not until we render the fat out of administration and overhead costs."

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