Rx for Baltimore

Our view: Rand study on hospital stays suggests need to revamp health care delivery

Baltimore has a shortage of primary care doctors. More physicians are converting their practices to fee-for-service boutiques. Others have moved out of the city to new professional buildings beyond the Beltway. Nurses are in demand. Community health centers across the city have more patients than they can reasonably serve. More people are out of work, and that means more uninsured people. And when someone without health care insurance is admitted to a Baltimore hospital, the public helps defray some of the cost of that patient's treatment. These factors all contribute to a health care system in Baltimore that is driven to treat the sick, when it should be working to keep people healthy.

When the Rand Corporation studied Baltimore's health care delivery system, it found an increasing number of city residents relying on hospitals to treat illnesses that could have been prevented with regular visits to a doctor. That pattern of treating the poor or uninsured is expensive, and more costly than it needs to be. The Rand study, which reviewed city hospital stays for 2000-2007, provides intriguing data on health care services that should spur a review of the effectiveness of the system in Baltimore.

Why are taxpayers subsidizing the most costly care, when those health care dollars potentially could serve more patients - and for less money - if the focus was on the front end of the system? Dr. Joshua M. Sharfstein, the city health commissioner, who requested the Rand study, says Baltimore's reliance on hospital care exceeds that of Washington, D.C., which has as poor a population. The imbalance reflects a basic flaw in the system: Primary health care doesn't get the attention or resources to keep a city like Baltimore relatively healthy.

Other cities face similar problems. But states have found ways to better manage their health care delivery by putting a priority on primary care. And the Rand study offers Maryland an opportunity to re-examine its care of the uninsured and poor and discuss ways to improve it. Dr. Sharfstein is calling for a summit; it's a conversation that should begin and receive support from policymakers, health care providers and hospitals as well.