Expanding access to health care

Our view: A proposal to reduce health care disparities appears promising, if it is accompanied by adequate safeguards against fraud

January 17, 2012

Gov.Martin O'Malley's administration is proposing to establish a number of health enterprise zones to address the glaring health disparities along racial and class lines that end lives prematurely and cost the state hundreds of millions of dollars a year in additional medical costs. This is a promising idea that deserves further exploration; the need is obvious, the disparities are well-documented and a plan to test the program's effectiveness through a series of pilot projects offers an affordable, relatively low-risk approach to the problem.

The health enterprise zones, modeled on the example of economic development zones, would offer doctors and community groups tax incentives to provide additional medical and support services in underserved rural and urban communities. The aim is to promote greater access to primary medical care and keep people with routine ailments from waiting until they are so sick they have to visit a hospital emergency room.

That large disparities in health and access to care exist in Maryland is beyond dispute. Infant mortality rates among black women are three times the rate among white women, and the life expectancy of a resident of an affluent Baltimore neighborhood like Roland Park is nearly 20 years longer than that of a resident of a poor one like Hollins Market. Hospital admissions for blacks with hypertension and asthma are three or four times the rates for whites, and Hispanics are more than four times as likely to not have health insurance as whites.

It's been just as well established that Maryland pays dearly for such inequalities. A legislative panel estimated that between 2003 and 2006 the state could have saved nearly $230 billion in direct medical costs had there been no racial, ethnic or class disparities in access to care. Other studies suggest that Maryland, which leads the nation in wealth, would lead the nation in health as well if such disparities were eliminated.

Focusing on keeping people healthy rather than on treating them when they become sick is the best way to reduce the disparities in access to care and the thousands of preventable deaths annually that result from them. That is also the overall thrust of the 2010 federal health care reform law, which aims to broaden access to care to the millions of Americans who currently lack health insurance.

But simply expanding insurance coverage won't be enough if it doesn't give health care providers incentives to improve the quality of service for disadvantaged and underserved communities. That's what the proposed health enterprise zones are intended to accomplish. Their job would not only be to perform routine procedures such as check-ups, vaccinations, pre-natal care for pregnant women and dental and eye care but also to teach families to access such services earlier and more effectively.

The zones would seek to attract for-profit health-care providers as well as the kinds of non-profit groups that already are operating in many underserved communities. That could provide a healthy element of competition in which for-profit and non-profit groups vie for clients by upgrading their facilities, staffs and the variety of services they offer.

Currently, the state is looking at tax incentives in the range of tens of thousands of dollars to encourage such groups to take root. That's a relatively small investment for the potential benefits of narrowing the state's health care disparities, but the regulations governing the health enterprise zones need to be carefully drawn to prevent the misuse of state Medicaid and Medicare funds.

Recent years have seen several well-documented cases of overbilling and other irregularities. That's why testing the proposed health enterprise zones' effectiveness in a pilot program where results can be tabulated and a complete financial audit performed is essential. As in so many areas, the devil is in the details. If the idea is to work, state regulators must make every effort to ensure that the money actually goes into expanding access to health care and improving the quality of services for residents, not the pockets of fraudulent or unscrupulous operators.

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