Md. health care system a ticking time bomb

August 19, 2001|By Barry Rascovar

MARYLAND'S inattention to a disintegrating health care system could prove a big headache for elected leaders over the next few years.

Everywhere you look on the health care front, there's trouble.

Hospitals are curtailing delivery of care because of state-imposed price controls.

Doctors are fleeing the state's Medicaid program because of abysmally low payments.

Teaching hospitals are hurt by the state's low reimbursements for uninsured patients.

Community psychiatric clinics are barely viable. Nursing homes are treading water.

There's a severe shortage of nurses, along with too few pharmacists and radiologists.

There's too little drug-treatment money to make a significant difference.

It's a mess.

Health care is barely on Gov. Parris N. Glendening's radar screen. Legislative attempts to find remedies are well-intended but not nearly enough.

The next governor could face a volcanic eruption of health care issues that have been suppressed beneath the surface for too long.

How, for instance, does the next governor deal with the 700,000 Marylanders without health insurance?

Will anything be done about the state's hospital price-control commission, whose objectives are decades out of date?

What about the state's bureaucratic nightmare known as the certificate-of-need process that hamstrings every hospital construction project and medical-equipment purchase? That, too, is sorely behind the times.

The Glendening administration has shortchanged health care programs, especially Medicaid.

In his most recent budget, the governor didn't even give an honest accounting of the state's unpaid health bills: He intentionally low-balled the expected Medicaid caseload and didn't budget for $32 million in medical treatment.

Payment rates for hospitals and doctors are embarrassingly low. The average cost of a routine visit by a Medicaid patient to a University of Maryland School of Medicine physician is $44. The Medicaid rate: only $17. That's a prescription for disaster.

No wonder the state's managed-care program for the poor is close to collapse.

No wonder so many Maryland hospitals are barely scraping by.

Or that state psychiatric hospitals are closing.

Or that you hear growing complaints about the eroding quality of health care.

Only Maryland sets prices for hospitals. Yet these are nonprofit facilities. Any "profits" are recycled into better medical equipment, better facilities, more and improved patient services.

Still, Maryland hospitals are treated as though they are greedy, private companies voraciously sucking every dollar from patients.

Health insurance companies promote that impression, and for good reason. There are profits for them if the state clamps down on hospital charges. But it's not always in the patient's best interest.

Not when hospitals reduce staffing to save money, or cut corners that affect patient comfort. Or push patients out the door not because it's good medicine but because of pressure from insurers and the price-control commission.

After years of shrinking margins, the hospitals finally got a break: Last month, the price-control commission gave them a whopping 3.97 percent increase. Problem is, that only matches the expected medical inflation rate.

So hospitals get just enough to keep up with the rising tide. Meanwhile, the acute nursing shortage is costing hospitals dearly, forcing them to offer bonuses and higher pay and to fork out money to personnel agencies to supply nurses.

There's also little money to keep current with new medical technologies or to give patients the kinds of enhanced services they are increasingly demanding.

And that's just the beginning.

Take that nursing shortage. The inflated salaries hospitals shell out draw nurses away from other health care facilities, such as assisted living and nursing centers. That, in turn, creates nursing voids that often can't be filled.

There's a two-fold problem. First, the Glendening administration has failed to face up to the state's health care obligations.

Second, the state's price-control system is squeezing hospitals so hard it's affecting the caliber of care.

That's an inevitable outgrowth of a 30-year-old cost-control setup that stifles free-market mechanisms.

If the situation worsens, this could be a front-burner issue in next year's race for governor. How will Lt. Gov. Kathleen Kennedy Townsend defend her administration's performance? Will she commit to doing a better job? Will some other candidate make health care a dominant theme?

The next governor won't have an easy time coping with this sensitive issue that can only be cured with expensive solutions. It's a ticking time bomb waiting to explode.

Barry Rascovar is deputy editorial page editor.

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