Sunday, December 14, 2008

The New York Times discussed the prospects (somehow that word doesn't seem appropriate in this context) for Medicaid cuts in New York. Actually, they're coming, in New York and most other states. It might be more appropriate to say the article gives a view into the abyss.

The relevance to prevention? Hospitals do wonderful things, and aren't just bricks and mortar edifices, but they constitute a significant investment in physical and organizational structure. Eliminating the clutter of inefficient and unnecessary things on hand is always hard than reducing spending on prevention.

It's also harder when organized constituencies are involved. Hospital unions will have a say in employee cuts. And, as noted in the article, a lot of Medicaid costs result from long term care for the elderly.

Those on the losing side are likely to be women and children, who make up the bulk of the Medicaid population, but don't require the same level of services. Unfortunately, if we cut primary care and prevention services, we cut the opportunities to ensure things stay that way.

Simple education for parents can save a significant portion of Medicaid dollars now being spent by parents who bring children to emergency departments. Similar results resulted in West Virginia (see fn 14)
New York State spends more on Medicaid than any other state, $2,283 per capita per year, twice the national average of $1,026, a state Health Department spokeswoman said.

Dr. Richard F. Daines, the state health commissioner, said the new budget would lay out a plan to pay more to primary care and clinic doctors, while shifting that money away from hospitals, which in theory would see fewer patients because of better preventive care.

At the health forum, Mr. Baker said, “It’s not about curtailing generosity, it’s about whether or not we’re getting real value for the money that we’re spending.”

Hospital executives say that they are not opposed to making that shift, but that cutting Medicaid is counterproductive if the goal is to promote primary care.

“There is a fundamental dilemma or contradiction here on the state level between their stated health care policy reform agenda, which is all about robust primary and preventive care and better disease management, and the inevitable outcome of these cuts,” Alan D. Aviles, president of the city’s Health and Hospitals Corporation, said. The corporation runs the city’s 11 public hospitals, which get about 65 percent of their income from Medicaid.

“I don’t know whether the executive proposal will find a way to balance those problems, or whether the deficit will be so overwhelming it’s going to trump everything else and it’s only going to be about cost-cutting,” Mr. Aviles said.

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