Preventive Care

Lack of health insurance drives many people to under- and over-utilize health services in ways that are costly to taxpayers and damaging to their long-term health. The ranks of the uninsured are swelling each day, and we can expect the human and financial costs of inadequate preventive and primary care to rise in proportion. Recent local reports have highlighted a classic example: our health financing system's shortsighted investment in acute care over preventive care. This newspaper's recent call for expanding coverage for women who have had a poor pregnancy outcome does not go far enough.

IS ANYBODY out there concerned about where health care is headed?Advice: You should be more than merely concerned. You should be scared. You should also be angry. No, furious.Let's dispense with I told you so, although the inevitable should have been clear from the start.Health care in the marketplace? The market dictates bottom-line considerations even as they clash with quality, access, etc. In the marketplace, poorer Americans are excluded and neglected by the millions, now approaching 50 million.

Baltimore Medicaid recipients who are enrolled in HMOs are generally satisfied with their care, according to a survey by CareData, a New York-based research company.Anthony Morgan, vice president of research for CareData, said the firm did the survey in hopes of selling reports to HMOs trying to refine their marketing. CareData provided questionnaires to 602 randomly selected HMO members who were re-registering for Medicaid.Of those surveyed, 29 percent reported they were extremely satisfied, while 60 percent were somewhat satisfied to very satisfied.

Already the largest physician group in the state, Doctors Health System is also moving into the business of overseeing care given by other doctors, as it announced yesterday a three-year contract with NYLCare Mid-Atlantic to manage care for its Medicare HMO.NYLCare will pay DHS a fee per member, leaving DHS responsible to pay for as well as oversee all care. "This makes Medicare dollars much more flexible," said Dr. Scott Rifkin, chairman of DHS. With this flexibility, he said, his group hopes to keep down medical costs by an elaborate program of preventive care -- for example, by providing scales to monitor the weight of elderly patients in danger of heart failure.

ORLANDO, Fla. -- Patients enrolled in health maintenance organizations were twice as likely to die of heart attacks as those in traditional health insurance plans, according to research presented at a meeting of the American Heart Association yesterday."

Proposals this week by the Clinton administration to trim federal Medicare reimbursement rates have area HMOs and hospitals worried, but teaching hospitals were encouraged by another element in the plan.If approved by Congress, the cuts could deflate profits in Medicare HMOs, which have been competing aggressively to sign up seniors. Medicare HMO enrollment in the state has quadrupled from about 10,000 in December 1995 to about 42,000 as of Jan. 1.Although Maryland hospitals are not directly affected by proposals to tighten Medicare hospital rates -- under Maryland's unique regulatory system, Medicare pays the rates set by a state commission rather than those set nationally -- hospitals still fear an effect.

It's 7:30 a.m., and on the 10th floor of the Alexander & Alexander building in Owings Mills, a vigilante group of doctors is plotting to take back control of its patients' health care.Scott Rifkin, 35, an internist in a rumpled suit and the leader of this revolution, rushes in with the agenda. As the hunt for coffee begins, he tells them that Sandy Granger, a new hire, will hit the streets Monday to help recruit doctors in Baltimore, Towson, Annapolis and on the Eastern Shore and wants every name on their lists.

There's a knock-down, drag-out fight going on in the hallways of Annapolis over a health-care proposal that epitomizes the kinds of agonizing decisions individuals in our society have to make. Proponents of the bill say it gives patients the absolute right to choose a health-care provider. Opponents say the bill will demolish cost-containment efforts and add hundreds of millions of dollars to the cost of obtaining health care.In an ideal setting, the proponents' argument would triumph. Americans have been spoiled by a health-care system that has enabled them to pick and choose their physicians at will without much thought about paying for it. After all, insurance paid nearly all the bill.

A study of doctors and clinics that care for many Medicaid patients in Maryland has found that the lowest-cost providers are not necessarily the worst, nor are the most expensive the best.When it comes to the overall health of patients, researchers at the Johns Hopkins School of Hygiene and Public Health and the state health department found that there was really no relationship between cost and quality of care.The findings suggest that policy-makers don't have to compromise care in their zeal to trim expenses -- as long as they monitor the work done by providers.

Going to the nurse's office at Hillendale Elementary School may not be as much fun as it used to be.Youngsters will still get kind words and prompt care, but they also might get a shot or give up a little blood. They'll even be able to go there for regular checkups and attention to chronic ailments.All this medical attention takes place in Hillendale's new "wellness center," the first of its kind in a Maryland elementary school -- although Baltimore County and other jurisdictions have put the centers in high schools.

Lack of health insurance drives many people to under- and over-utilize health services in ways that are costly to taxpayers and damaging to their long-term health. The ranks of the uninsured are swelling each day, and we can expect the human and financial costs of inadequate preventive and primary care to rise in proportion. Recent local reports have highlighted a classic example: our health financing system's shortsighted investment in acute care over preventive care. This newspaper's recent call for expanding coverage for women who have had a poor pregnancy outcome does not go far enough.

The Maryland insurance commissioner is weighing whether "concierge" medical care - in which physicians provide comprehensive services for a flat annual fee - should be considered a form of health insurance and thus regulated. "Our concern is whether the practices are structured in a way to constitute insurance," Ralph Tyler, the commissioner, said after a holding an information hearing on the issue yesterday. But advocates of the model argued that patients have the right to pay extra for services that are not covered by insurance.

With the economy in trouble, 50-year old Elizabeth McCarthy is unemployed, but she and her husband Jay, 57, aren't worried about health care. The Ellicott City couple were among the first of more than 1,100 Howard County residents who flocked to apply for the county's new health access plan for the uninsured when it launched last month. "It takes an awful lot of stress off you," said Jay, a self-employed furniture finisher. Elizabeth added, "We've gone without when we should have had care."

The Medicare system is far more expensive than it should be, but with some simple tinkering, its inefficient backbone could easily be repaired ("Fixing Medicare," editorial, July 28). Under Medicare's current reimbursement policies, high-cost tests and procedures are well-reimbursed while preventive care is not. Yet study after study has demonstrated that primary care medicine emphasizing prevention is more cost-effective and leads to better health outcomes than our present procedure- and specialist-oriented medical system.

The nation's largest health insurer announced yesterday what is believed to be the country's first effort to tie the pay of its employees to the well-being of its consumers. WellPoint Inc., with 34 million insured members nationwide, including nearly 8 million through its Blue Cross of California unit, will base part of its workers' annual bonuses on how well its consumers fare in things like immunization rates, cancer screenings and diabetes management. Employees will be rewarded, for example, if they get more diabetic patients to undergo preventive care that might ward off blindness or limb amputations, common complications of the disease.

A report card that evaluated the quality of U.S. health care has concluded that American adults receive only about half of the treatments recommended for both acute and chronic conditions and half the recommended preventive care. The Rand Corp. report, based on one of the largest studies of health care quality ever undertaken, says inadequate care translates into tens of thousands of deaths and unnecessary complications, posing "serious threats" to the public's health. The study was published in the journal Health Affairs.

PRINCESS ANNE - The first thing that strikes a visitor to the University of Maryland Eastern Shore is its size: more than 600 acres, beautifully landscaped and dotted with dozens of large, handsome buildings, many of very recent vintage. It is easy to imagine the campus supporting a university of 10,000 students - and surprising to learn that it holds 3,200. Into this setting comes new UMES President Thelma B. Thompson, a former vice president at Norfolk State University in Virginia. Thompson arrives at the historically black university with ideas that vary widely but share a common goal: to give UMES ambitions equal to its real estate.

Doctors are said to make lousy patients. Now comes a study indicating that many docs avoid being patients altogether. Researchers at Johns Hopkins School of Medicine decided to examine how well doctors took care of their health after previous studies suggested that doctors' bad habits -- among them smoking and drinking -- influence what they tell patients. Using annual health surveys completed by graduates, they found that a surprising number of physicians -- about one in three -- had no regular source of care, even though they had ready access and were better educated and could more easily afford it than the average American.

For a physician who has spent his entire professional life in the staid environs of academic medical centers, it's been a bit of a jolt to read columns by television critics comparing a series about my institution to "Survivor" and "Big Brother." Last year, when ABC-TV news executives persuaded me to allow them extraordinary access to film "Hopkins 24/7," a six-part, prime-time series, I hadn't even heard of the other reality shows that would make Johns Hopkins part of this summer's popular genre.

IS ANYBODY out there concerned about where health care is headed?Advice: You should be more than merely concerned. You should be scared. You should also be angry. No, furious.Let's dispense with I told you so, although the inevitable should have been clear from the start.Health care in the marketplace? The market dictates bottom-line considerations even as they clash with quality, access, etc. In the marketplace, poorer Americans are excluded and neglected by the millions, now approaching 50 million.