President Bush says his plan for managed health care for the poor is already working at the East Baltimore clinic he visited yesterday.
But health experts here say the jury is still out on whether health maintenance organizations such as the East Baltimore Medical Center are the best model for the country.
"There is a lot of controversy around how to best deliver and pay for medical care to Americans and the poor in particular," said Diane Rowland, a professor at Johns Hopkins and director of the new Kaiser Commission on the Future of Medicaid.
While the "managed care" Mr. Bush advocates is increasingly popular, she said, experts are seriously concerned about whether these programs offer quality care. In addition, she said, there are questions about how much money these programs really save.
Managed care, or "coordinated care" as President Bush called it yesterday, refers to guiding or restricting patients to certain doctors and services to streamline health care and reduce costs.
In many programs, including HMOs, individual patients or their employers pay a flat fee regardless of the type of medical services they need.
For example, the East Eager Street medical center Mr. Bush visited is part of a system of HMOs owned by the Prudential Insurance Co. It is staffed by Johns Hopkins doctors. The state Medicaid program pays the HMO fee for two-thirds of the HMO's members, while private employers pay for the remainder.
In his talk yesterday, Mr. Bush cited the Maryland program as an affordable and quality alternative to national health insurance. He said Congress should make it easier for other states to set up such programs for the poor.
He said the traditional practice of paying a doctor for each service is too expensive and often deprives the poor of access to regular doctors who can deliver preventive care.
"I want to make coordinated care the norm, not the exception for Medicaid," Mr. Bush said.
Up to 37 million Americans lack health insurance, analysts say, and medical bills for the poor are straining state budgets everywhere. In Maryland, they take up 12.3 percent of the state budget. As a result, most states have some form of managed care.
In Maryland, 75 percent of medical assistance patients have some form of managed care. The state offers the poor several options:
*An approved HMO. The state Medicaid program has contracts with three of them, including Prudential, all in Baltimore.
*The new Maryland Access to Care program, or MAC, in which patients choose their own doctors from a state-approved list.
MAC is a variation of the traditional fee-for-service system. It's intended to get people into the habit of going to doctors instead of hospital emergency rooms for everyday care. They get to choose their own doctors.
Under the MAC program, some 1,600 doctors have agreed to serve as general practitioners for Medicaid patients.
"Managed care tends to have people thinking HMOs," said John J. O'Brien, a state economist who helped develop MAC. "There is a whole range of care in between."
Officials hope the MAC program, which began only in December, will save $20 million to $30 million in a $1.5 billion state Medicaid budget. But analysts hope that MAC and other programs aimed at kidney patients and drug abusers will provide better care, too.
More than 400,000 Marylanders receive medical assistance benefits. Of these, 70,000 belong to Prudential and two other HMOs. Another 230,000 people are expected to sign up with MAC. So far, 130,000 people have selected their doctors in the program.
OC Dr. Rowland of Hopkins said studies show that patients' medical
costs initially decline when HMOs start up and their fees are low. But, over time, HMO costs increase to the levels of traditional health care delivery methods.