VNA may have become outmoded


May 31, 1994|By Patricia Meisol | Patricia Meisol,Sun Staff Writer

It was a different era of health care reform when the Visiting Nurse Association of Baltimore was founded in 1895. And against what is happening in today's medical marketplace, the VNA may have outlived its usefulness.

Nursing 100 years ago had become a profession -- training schools for it had opened 40 years earlier, thanks to Florence Nightingale -- and there was great social foment, partly a rebellion from the rigid social rules of the Victorian era. It produced a movement to help care for the sick and the poor.

The organization that became the VNA moved from the homes of wealthy women to the streets, where an organized cadre of nurses kept regular contact with the homebound elderly and sick, sometimes serving as their only link to the outside world.

The need for the VNA service remained strong through much of the century and into the 1960s and 1970s, when a new batch of social programs began to supplement and even replace the volunteer fund raising that financed past efforts to provide health care for the poor.

Today, the federal and state governments pay 80 percent of the VNA bill for the elderly through Medicare and Medicaid. Private funds pay for the people who are poor but not poor enough for the government program.

It is a rich and laudable history that the VNA brought to the bargaining table last year when it approached outside health care companies in a bid for cash.

Its sale last week to a group of hospitals and medical care companies may be evidence that it has become outmoded -- more and more, private companies and the hospitals themselves are taking on the role of caring for the ill or sick at home. Today the value of the VNA is as a delivery system for the home health care made possible by technology.

Home health care

The popularity of home health care will grow no matter what happens to health reform proposals on Capitol Hill this summer because it is less costly and in many cases patients prefer it.

But whether the current era of health care reform will be shaped by government action or realignments of the market is still to be seen. Henry Saveth, principal in the New York office of Foster Higgins, benefits consultants, likens the pressure on Congress to pass a national health plan to the fifth inning of a baseball game: Still too early to call.

In the end, he predicts whatever passes will be a lot more "user-friendly" than the grand plan by the Clintons for alliances that would buy care and regulate its use.

Mr. Saveth says there are 10 major issues that need to be resolved before, as he sees it, people will feel comfortable tampering with 14 percent of the U.S. economy. They include who would pay for universal coverage and how health care would be delivered. The image of long lines at the motor vehicle office comes to mind. "There's concern over placing the 21st century's biggest product in the hands of the government," Mr. Saveth said.

There are also tax issues, price control issues, and the issue of whether to give states the option to design their own plans. Thus Mr. Saveth points to an old axiom in Congress -- "that it is easier to enact a basic program this year and add to it later."

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