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Thursday, May 27, 2004
Baldacci drafts health care plan
Copyright © 2004 Blethen Maine Newspapers Inc. | ||||||
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Maine hasn't had a state health plan since the mid-1990s. Plenty has happened since. Maine is spending more than ever on health care, but Mainers are among the sickest in New England, and tens of thousands lack health insurance. With health care costs expected to reach $6.9 billion this year - 16 percent of the gross state product - the state health plan is making an ambitious comeback. Gov. John Baldacci's administration took the wraps off the draft of a one-year plan Wednesday that makes recommendations regarding the cost, quality and accessibility of health care in Maine. "It's basically a way to rationalize the health system to recognize this is a huge part of our economy and a big industry and we ought to be more careful how we plan it," said Trish Riley, director of the governor's Office of Health Policy and Finance. While the health care industry agrees that Maine needs a statewide plan, some members are concerned that cost is its driving force. The plan suggests establishing statewide "health expenditure targets" across the health care sector, which does not sit well with hospitals that have been asked this year to voluntarily cap cost increases and operating margins. Mary Mayhew of the Maine Hospital Association worries spending targets would prevent hospitals from purchasing the best and latest equipment, or providing public health programs such as nutrition classes. "A target is an arbitrarily determined number that may not allow us to make the right investments in health care services," said Mayhew, vice president of government affairs. "Fundamentally, hospitals exist to provide health care. The more we can do better, the more we will reduce costs." Hospitals and some doctors' offices also would be affected by the plan's recommendation that medical expansion be more strictly regulated. It is the commissioner of the Department of Human Services who grants certificates of need, and more than $162 million in anticipated projects are in the queue. But the governor's Office of Health Policy and Finance will help narrow the list. In June, it will propose a cap on how many capital expenditures can be approved in a year, and hold a public hearing later in the month. The measure must be approved by the Legislature. The state health plan is part of the nationally recognized Dirigo Health reform law passed a year ago, best known for creating a health insurance program that aims to cover 138,000 uninsured Mainers by 2009 through affordable and benefit-rich plans. A group of people appointed to guide the creation of the state health plan - the Advisory Council on Health Systems Development - will take public comment on the draft and hold a public hearing June 4 in Augusta. The governor's Office of Health Policy and Finance will then issue a final version of the plan around June 15, Riley said. The hospital association, however, plans to push for legislative approval of the state health plan. The draft plan also says the health care system should: Encourage hospitals and doctors to provide the best care by rewarding performance; Critically examine medical outcomes using Maine's information technology systems to discover the best ways to deliver care; More effectively treat the large proportion of people with mental illness who also are substance abusers, in order to improve outcomes and save money; Reduce the number of uninsured Mainers to 31,000 this year through Dirigo Health. The state program is expected to be launched this summer. The one-year plan is transitional, and would take effect July 1. A more far-reaching biennial plan was to be released this month, but Riley said it needs more time, research and public input. It is now scheduled to be issued in July 2005. Maine had state health plans from the 1960s through the 1970s, said Andy Coburn, the director of the Institute for Health Policy at the Muskie School of Public Policy in Portland and a member of the advisory council for the state health plan. But Congress abolished the federal law governing state health planning during the Reagan administration and funding for the state programs vanished, Coburn said. Maine's Bureau of Health revived the state health plan in the 1990s, but it focused mostly on the health status of Mainers, and their access to health care. "It did not really focus on cost-containment issues or health care delivery, or financing," Coburn said. "This plan is much more serious in its intent on focusing on some tough issues that Maine really needs to grapple with."
Josie Huang can be contacted at 791-6364 or at:
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