June 03, 1997
SHIFTING MARYLAND'S 330,000 Medicaid recipients to managed-care programs was initially envisioned as a way to stem the rapid rise in government costs for this $2.3 billion program. But as the transition gets under way this week, the focus is on better medical care, not saving money.
That is how it should be. The biggest benefit could flow from giving each patient a "medical home" with a primary care physician who is responsible for that individual's well-being. A flat fee to the participating health-maintenance organizations acts as an incentive for these physicians to make sure Medicaid clients receive preventive treatment and that diseases are handled as soon as they crop up.
What a change this could make for the state's poor and disabled. Under the old Medicaid system, too many patients turned to hospital emergency rooms for help even for a bad cold. That not only proved extraordinarily expensive for taxpayers but it meant patients lacked a family physician who could quickly handle such a situation without much expense or delay.
A healthier Maryland Medicaid population is expected to have a major impact on state hospitals, which anticipate a 20 percent loss of Medicaid business. That should be viewed as good news, because it means fewer recipients will need hospitalization.
Over the long term, a managed-care Medicaid program could consume a smaller portion of the government's health-care dollar. There is no guarantee this will happen, though. Kinks in the new system are inevitable. For instance, the state's initial reimbursement rates may prove too low for companies to turn a modest profit without scrimping on medical services.
Still, this step was long overdue. Providing more personalized, managed care for the poor and disabled makes sense from a medical standpoint. That, in turn, should wring some of the excess costs out of Maryland's health-care system. While the initial transition may have its rough spots, the end result should be worth it.
Pub Date: 6/03/97
