How to Solve the Hospital Crisis

Is the title of an op-ed in the Post, from early August. They suggest that the District and Maryland should coordinate the provision of their health care systems around Washington. This is something I suggested in January 2006, and earlier. See the blog entry "Health Planning vs. Hospital Planning redux." From the entry:

Another issue that I seem to connect more than most to the health care discussions in DC are the financial problems experienced by Prince George's County Hospital in Cheverly (visible through the trees from the BWI Parkway). The Examiner also wrote about this last week, in the article "Pr. George s Hospital strapped for cash."

PG County Executive Johnson continually berates Dimensions Health Care for poor management, and maybe that's an element of the problem, but like the County's crisis in public safety, it's more likely to involve "systemic and structural" problems, in this case with the health care system and its failure to adequately care for chronic conditions, as well as the cost of catastrophic care for people without insurance.

Frankly, if this isn't a call for some regional thinking, I don't know what is. I would be inclined to support looking at the issues of PG Hospital, Greater Southeast Hospital, and Howard University Hospital and Medical School in a more connected fashion...

Still despite the been there, done that aspect, I like the points they make, even though a few of us have made the same points for awhile (e.g., I have been arguing for community-based services since I started writing the blog 30+ months ago--if drug stores and supermarkets can set up clinics in stores why can't public health authorities use the same idea?).

From the op-ed:

· Objective and independent evaluation of the needs of the community and the ability of the surrounding area to address those needs. This is critical, both for the baseline that it would establish and because the process is fraught with social, political and economic minefields.
· The purchase of the two facilities. While this may lead to the temptation to politicize their administration, the intersection of for-profit health care and a population that relies heavily on public assistance has proven untenable.
· Luring talent to create and lead this innovative approach, compensated at a level that would retain that talent.
· Affiliation with one or more academic medical systems, bringing additional medical talent and specialty care capabilities.
· Enhancing reimbursement for the treatment of medical conditions prevalent in this region.
· Pursuing grants designed to alleviate morbidity and mortality in targeted ways. This should be done through a combination of government and private foundation funding sources.
· Integrating associated services -- school health, dental, immunization, health promotion and education -- into the fabric of the community. This calls for links to community services organizations and coordination with churches and other outlets that could host initiatives to integrate health care into the community, such as parish nurse programs.

This is from a blog entry in June:

The focus on hospitals vs. issues of health

The newspapers are full of articles about the debacles at both Prince George's County Hospital and Greater Southeast Hospital in DC. And there was the fight over creating a new Howard University Hospital in Ward 6. At that time many argued that there was a big difference between hospital planning and health and wellness planning.

See today's Post editorial about Greater Southeast: "Hospital in a Tailspin," subtitled "The mayor is concerned, but that won't solve the problem." And this piece about PG County Hospital: "A Bitter Pill For County Liaison to Hospitals."

Neal Peirce's column this Sunday is about regional planning in Boston. The column makes this point:

There's something wrong with this picture, notes Kahn: "We aren't aligning health spending with the actual determinants of health -- 50 percent of which are all about lifestyles and another 20 percent the environment, including exposure to toxins and only 10 percent access to doctors, clinics and hospitals.