The Maryland experience and a practical proposal to expand existing models in ambulatory primary care.
Two unique models for caring for the uninsured and underinsured are operating in Maryland. The first is a group practice, primary care model with a unique ambulatory Medicare waiver that has had a positive impact on patients and physicians. The second is a financial model--an all-payer prospective rate-setting system for all critical care inpatient hospitals that, during a 13-year period from 1977 through 1989, has saved the citizens of the state approximately $5.361 billion, has allowed hospitals to provide $1.657 billion of charity care and bad debts, and has earned $517 million in net profits. The reasons for the success of each of the models are discussed and form the basis for a practical and politically feasible proposal: merge the best aspects of each model into an ambulatory primary care-based model financed through an all-payer prospective charge system.
Riley
W A
WA
Department of Medicine, Greater Baltimore Medical Center, MD 21204.
Schneckenburger
W A
WA
D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration*; D015142:Baltimore; D003151:Community Health Centers / Q000191:economics; D007882:Legislation, Hospital; D008396:Maryland; D008484:Medicaid / Q000458:organization & administration; D008489:Medical Indigency; D006278:Medicare / Q000458:organization & administration; D008962:Models, Theoretical; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation; D011907:Rate Setting and Review / Q000331:legislation & jurisprudence; D012017:Referral and Consultation; D013221:State Health Plans / Q000458:organization & administration*; D014481:United States