Health care for poor is a sickening maze

March 29, 2001|By Barry Rascovar

GETTING government officials -- and bureaucrats -- to take sensible steps that help rather than hinder people can be next to impossible.

It often takes dynamite, in the form of legislative intervention, to force change. The bureaucracy won't act unless ordered.

Take the dysfunctional way the state deals with health care for poor mothers and youngsters. It seems as though the system is at war with itself.

For instance, a state agency with a $4.6 billion budget can't print an accurate, up-to-date physicians directory to help poor mothers find doctors for their kids.

This 9,000-member bureaucracy can't figure out how to get medical insurance cards to Medicaid mothers of newborns.

As a result, infants often go without a doctor's care for several months, or physicians treat ill babies for free.

Record-keeping at the state Department of Health and Mental Hygiene is so poor there's no list of who's treating 487,000 Medicaid recipients. The situation is compounded by a bizarre system of "auto-assigning" Medicaid patients at least once a year -- at random -- to participating doctors.

The result is confusion, chaos and ineffective health care, especially for more than 300,000 Maryland kids.

For more than three years, advocacy groups have complained about these glitches. Yet nothing has changed.

The intentions of top health department leaders are admirable, but they have been unable, or unwilling, to light a fire under the bureaucracy.

How hard could it be to put out an up-to-date list of physicians still accepting Medicaid recipients? Apparently, it's beyond the capabilities of health bureaucrats.

In Montgomery County, a survey of pediatricians revealed the depth of the problem. This year's directory lists:

Doctors who no longer participate, have gone out of business or won't take any new patients.

Doctors whose names are repeatedly listed -- as many as 23 times.

Wrong addresses, wrong office suites, wrong cities and wrong or disconnected phone numbers.

That's only part of the insanity. A Medicaid mom with kids might reside near the city-county line, but she only receives the directory for the jurisdiction where she lives. And if she has five kids, they'll get six directories in the mail.

None of this makes sense. In a computer age, it's mind-boggling that such a huge state agency lacks an electronic, easily updated physicians list.

This isn't exactly rocket science -- except when you're dealing with an entrenched bureaucracy.

Remember, this is the department that has yet to figure out how to compile a list of each Medicaid recipient's primary doctor.

And instead of taking a sensible approach that keeps kids with the doctor who's been treating them, the bureaucracy spins the roulette wheel and randomly reassigns them to different pediatricians every year.

Even worse is the absurd situation at the hospital once a child is born. You'd think that by now the state would have a plan to make these infants immediately eligible for medical care.

Think again. This is the bureaucracy.

First, the hospital must complete and fax a form to the health department.

Second, the state's paper-shufflers must "process" the form, enter the baby's Medicaid number, assign the baby to an HMO and transmit the baby's name to the HMO.

The HMO, of course, has its own bureaucratic processing.

Finally, the health department assigns the baby an HMO number, a designated pediatrician and an ID card is mailed out.

This could be done in minutes or hours. But it takes the state anywhere from 14 to 60 days -- or longer.

Without that ID card, the mother can't get her infant checkups or drugs or specialized care. Doctors will treat sick babies -- but the state won't pay.

Maryland is in violation of federal law. Tell that to the bureaucrats.

So the state legislature has wasted valuable time hammering out bills that will force the health department to use common sense.

This week, the state Senate passed, on unanimous votes, bills that would automatically give new-borns 60 days of medical treatment without a Medicaid card; that would end the irrational and self-defeating system of "auto-assigning" recipients randomly to doctors; and that would mandate a computerized, correct and updated physicians directory.

No wonder advocacy groups feel frustrated. No wonder legislators are infuriated with the administration's lack of diligence on medical matters.

Gov. Parris N. Glendening hasn't focused on health care matters. It's not one of his issues. That inattention is beginning to take a toll. It's an unhealthy situation.

Barry Rascovar is deputy editorial page editor.

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