Health care held cap­tive

Baltimore Sun - - MAYLAND VOICES - Dr. Andy Lazris, El­li­cott City The writer is author of “Cur­ing Medi­care: One doc­tor’s view of how our health care sys­tem is fail­ing the el­derly and how to fix it.”

I read with in­ter­est the front-page story about Mary­land’s at­tempt to con­trol health care costs in an ef­fort to re­tain its Medi­care waiver (“Mary­land works to bring doc­tors, nurs­ing homes into Medi­care cost con­trol pro­gram,” Oct. 1). Much of the onus for the health care trans­for­ma­tion em­anates from hospi­tals, who have the most to lose. As a pri­mary-care doc­tor who cares for the frail el­derly and also some­one who has stud­ied and writ­ten about our health care sys­tem, I see no move by any po­lit­i­cal en­tity or hospi­tal in Mary­land to ini­ti­ate sen­si­ble change in our bloated and in­ef­fi­cient health care de­liv­ery sys­tem.

We in pri­mary care have very prag­matic so­lu­tions, but we al­ways go un­heard. Why? Be­cause in any mean­ing­ful re­form in which pa­tients ben­e­fit and the sys­tem saves money, there will be two losers: spe­cial­ist doc­tors and hospi­tals, and they are the ones who hold all the po­lit­i­cal clout. When I see my frail el­derly pa­tients whisked to hospi­tals be­cause they have no other op­tion, when I see their spe­cial­ist doc­tors flood them with detri­men­tal pills and ex­pose them to a rash of dan­ger­ous (but prof­itable) tests and pro­ce­dures, I don’t have to look very far to see why our health care sys­tem is fail­ing.

While pre­cise num­bers are not avail­able for Medi­care, for Mary­land’s CareFirst pro­gram 20 per­cent of to­tal cost goes to hospi­tals and 27 per­cent does to spe­cial­ist physi­cians. Pri­mary care doc­tors ac­count for 5 per­cent of CareFirst spend­ing. And we know from am­ple lit­er­a­ture that in ar­eas of the coun­try that are spe­cial­ist-dom­i­nant and have a low pri­mary-care pres­ence, health out­comes are worse while costs es­ca­late.

For Mary­land to be suc­cess­ful in fix­ing the sys­tem, we have to rein in spe­cial­ists and hospi­tals while in­cen­tiviz­ing pri­mary care. Since spe­cial­ists and hospi­tals are lead­ing the re­form ef­fort, it is very du­bi­ous that any­thing mean­ing­ful will oc­cur.

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