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PAR Calls for Action in Health Care Reform

PAR has just released a health care policy brief that analyzes accessibility to health care in Louisiana and outlines six recommendations for reform that would increase the availability of primary and preventive care throughout the state. The report titled “Action Steps for Access to Care” describes the cost savings that could be realized by shifting health care for the poor and uninsured out of the emergency rooms and into doctor’s offices.

“Louisiana’s health care system is organized to deliver inefficient institutional care at the expense of primary and preventive care,” said PAR President Jim Brandt. “Spending priorities in the health budget are focused on institutions and providers, rather than patients.”

This PAR research brief examines the state’s options for improving access to basic health care services, especially primary and preventive care. It finds that Louisiana lacks the infrastructure to provide its citizens, especially the uninsured population, with basic health care services throughout the state. As a result, hospital emergency rooms are providing routine, often delayed, care at higher costs than necessary.

For each ER visit that can be transferred to a doctor’s office or clinic, a savings of around $300 can be realized. If just half of non-emergency ER visits can be diverted to non-hospital based primary care, a conservative estimate of potential savings would be $135 million per year, including $40 million per year in state funds.

“Action should be taken now on health care reform. The first steps outlined in this report will lay the groundwork for the system-wide changes that will hopefully follow,” Brandt said. “The major question of how to restructure and rebuild the charity hospital system should not be placed on the back burner while the recommendations in this report are implemented. Rather, debate over hospital care for the poor and uninsured should intensify as primary and preventive care options are expanded.”

PAR recommends the following action steps to improve health care accessibility in Louisiana:

  • Establish an initial investment of $50 million in state or block grant funds to assist in development of private-sector Federally-Qualified Health Centers (FQHCs), satellite FQHC sites or Rural Health Clinics (RHCs) statewide, with emphasis on the immediate needs of the New Orleans area.
  • Raise Medicaid fees to the Medicare payment rate for primary care physicians and other physicians in short supply. Medicaid fee increases could be phased in over a three-year period at $12 million per year in state funds. A special rate should be established for physicians in Orleans, Jefferson, St. Bernard and Plaquemines parishes to assist with extraordinary expenses related to treating Medicaid patients in the post-Katrina environment.
  • Restore medical care to rural parishes and other underserved areas by providing incentives for primary care physicians to practice in those areas. Incentive programs would require an initial investment of $25 million in state or block grant funds.
  • Double the enrollment in school-based health centers by implementing an aggressive development program. Establish an initial investment of $10 million in state or block grant funds for start-up and development of school-based health centers.
  • Relax practice requirements for non-physician clinicians or mid-level practitioners to enable them to practice independently in some cases, particularly in those underserved areas where there is no physician presence.
  • Provide no-interest loans to physicians in the Greater New Orleans region to assist them in re-establishing their medical practices. Priority would be given to physicians in private practice who are also “safety-net providers.” The initial cost of this program would be $25 million in state or block grant funds with the expectation that these loans would be repaid during a specified period.

The gridlock that developed over the future of charity hospitals should not be allowed to impede the immediate and significant steps forward on other problems that are just as crucial to solve but much less divisive. No matter what decisions ultimately are made regarding the state’s charity hospital system, increased access to primary care providers for both the insured and uninsured populations is essential to improve the health prospects for Louisiana.

This is the first report in an ongoing series of PAR health care policy briefs highlighting major issues and recommending reforms that affect health care programs and state and federal spending in Louisiana. PAR’s overview of the state’s health care system and its deficiencies, as well as the challenges and opportunities presented by hurricanes Katrina and Rita, was published in April 2006. Future briefs will focus on other specific issues, including the challenge of providing for the uninsured, long-term care for the elderly and persons with disabilities, and state Medicaid spending.

Primary author of this report was David Hood, PAR senior health care policy analyst.

For additional information or to obtain a copy of the report, write to PAR at P.O. Box 14776, Baton Rouge, LA 70898-4776, call (225) 926-8414 or visit PAR’s Web site at www.la-par.org.

For a copy of the report in PDF format click here.

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