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News Maryland Harford County Bel Air

Hospital management change likely just the latest [Editorial]

Probably the one thing that's fair to say about the state of health care in this country is a lot of people have a lot of strong feelings about it.

Beyond that, there's unlikely to be much agreement. What some folks think is good, others think is bad.

Most of the attention in the past year has been on the federal Affordable Health Care Act, which has come to be called Obamacare. Strong though feelings on all sides about the federal health care law are, it did not come to into being in a vacuum, and a lot of same forces that have made health care policy domestic policy debate issue No. 1 in this country also led to the lamentable, but probably inevitable, loss of local control over Harford County's two local hospitals.

The independent entity that became Upper Chesapeake Health began in the very early 1900s when community leaders in Havre de Grace established Harford Memorial Hospital. Over the decades, the hospital grew and modernized. In the mid 1900s when the trend was for such not-for-profit organizations to form arrangements with local governments, that's what Harford Memorial Hospital did. It fell squarely within the realm of health care organizations established for the public good, not private profit.

Though initially not held in as high a regard by the general public, for-profit hospitals came in to their own and by the 1970s there was one in Harford County, Fallston General Hospital.

The health insurance business followed a similar track. Initially, the Blue Cross and Blue Shield organizations were established with profit for the insurance company not being a motivation. Instead, the idea was to help provide economic stabilization for doctors, hospitals and medical professionals by ensuring people with coverage would be able to pay their bills, even if something catastrophically expensive happened.

Though profit wasn't necessarily a motivation, there was a lot of money in the mix, and private, profit driven health insurance companies came into being. Meanwhile, as technology increased, the cost of medical care increased, and the financial pressure on insurance companies – profit motivated and otherwise – also increased.

The trend in both health insurance and health care has been decidedly in the direction of bigger is better. At this late date, many community-based non-profit hospitals have faded from the scene, having been subsumed either by major for profit corporations like Humana or by major not-for-profits like Johns Hopkins or the University of Maryland Medical System (which is where Upper Chesapeake ended up).

Advances in medicine in the time that these market and economic changes have occurred have been nothing short of miraculous and have been made possible, in no small part, by the vast amounts of money involved in the system, some of which comes from private insurance, and some of which comes from governments and institutions of higher learning.

It's come to the point that it's just about impossible to distinguish the old public charity hospitals from for profit ones, and profit motivated insurance companies from ones with other foundations. Indeed, there was a move afoot a few years back that would have allowed Maryland Blue Cross and Blue Shield to have joined the ranks of the for-profits, though it failed to come to fruition.

Recognizing changing trends in the industry, leaders of Harford Memorial formed Upper Chesapeake Health in the mid-1980s and acquired Fallston General in late 1986. Months later, the organization severed all its ties with the county government.

By the early 1990s, however, there was a span of about a decade when local hospitals lost the faith and support of the community. Substantial management changes, followed by the construction of Bel Air's Upper Chesapeake Medical Center, helped turn that around, and it's unlikely any of those changes would have happened without there having been local control over the management of the local hospitals.

The deal to merge Upper Chesapeake Health with the University of Maryland Medical System takes away a good deal of that local control, which isn't a particularly welcome prospect. Still, the University of Maryland system has an international reputation as a first class operation, so the situation is far from terrible. Actually, there are more than a few reasons to view the change as having its positive sides.

The reality, however, is that this arrangement is probably no more permanent than any other organizational arrangement made in local or regional health care in the past 50 to 100 years, which is to say not very permanent at all.

Copyright © 2015, The Baltimore Sun
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