BALTIMORE—Baltimore spends more per capita on its Medicaid population than six other comparable cities around the United States yet has the highest rate of people reporting they cannot get care when they need it—one in five city residents—according to a new study that will be published in a major health journal this month. The report, "The Urban Safety Net: Can It Keep People Healthy and Out of the Hospital?" will be released at a news conference at the Open Society Institute-Baltimore on June 8, 2004 at 10 a.m.
Compared to the cities of Atlanta, Boston, Chicago, Detroit, Oakland, and Philadelphia, Baltimore had comparable rates of poverty, percent uninsured, and proportion without a source for usual care. However, the city also had the highest rates of emergency department visits per person, hospital admissions, and—most telling—preventable hospitalizations among all the cities studied.
These findings are echoed in data collected by Baltimore REACH, a new consortium promoting social justice and community health in Baltimore, and OSI. Two hundred and forty-eight adults were surveyed in June and July of 2001 while accessing community agencies. They identified 174 different sites where they were receiving health and social service care with only 62 sites (35.6 percent) reported by more than one person. Baltimore is also the only city among the seven studied that did not have a federal Community Access Program grant meant to help coordination of care among providers.
"These data suggest that we are not spending our money wisely," said Thomas O’Toole, MD, a program officer with OSI's Medicine as a Profession (MAP) program at OSI-Baltimore and co-author of the report, which will appear this month in the Journal of Urban Health. "Because we are not integrating and coordinating hospital-based health care with community-based health and social services agencies, we have created a system that costs more and provides less, especially compared with other urban centers. The experience in other cities points to alternatives to the rollbacks in Medicaid eligibility and services being proposed and enacted in Annapolis. We should instead be looking at how we can do a better job with what we have. It costs far less to care for someone in the community than in the emergency department or the hospital."
Barbra Levin, executive director of the new Baltimore REACH Community Health Consortium, agreed. "The data bear witness to what those of us who work with poor Baltimore families see on a daily basis," she said. "By launching Baltimore REACH we hope to provide even better care, share lessons learned and advocate with policymakers on behalf of our low-income clients to try to address these unmet needs."
Formed in 2000 as a MAP initiative, Baltimore REACH—which stands for "Research Education Advocacy and Community Health"—has grown into a network of community-based healthcare providers that offer medical services; train medical students in community-based approaches; advocate for the health and social services needs of Baltimore’s poor and indigent; and work to better coordinate services among themselves and state and local agencies. In May, the group received a generous gift from the Leonard and Helen R. Stulman Charitable Foundation that will allow the members to provide improved indigent care.
Baltimore REACH Members include: Beans and Bread Outreach Center, Chase Brexton Health Services, Franciscan Center, Healthcare for the Homeless, Health Education Resource Organization, Paul’s Place, St. Michael’s Outreach Center, and The Shepherd’s Clinic.
O’Toole, Levin, and representatives from Baltimore REACH will be available at the news conference for interviews. Copies of the study will be distributed at the event.
About the Open Society Institute
The Open Society Institute (OSI) is a private operating and grantmaking foundation that promotes the development of open society around the world. OSI's U.S. Programs seek to strengthen democracy in the United States by addressing barriers to opportunity and justice, broadening public discussion about such barriers, and assisting marginalized groups to participate equally in civil society and to make their voices heard. U.S. Programs challenge over-reliance on the market by advocating appropriate government responsibility for human needs and promoting public interest and service values in law, medicine, and the media. OSI's U.S. Programs support initiatives in a range of areas, including access to justice for low and moderate income people; independence of the judiciary; ending the death penalty; reducing gun violence and over-reliance on incarceration; drug policy reform; inner-city education and youth programs; fair treatment of immigrants; reproductive health and choice; campaign finance reform; and improved care of the dying. OSI is part of the network of foundations, created and funded by George Soros, that are active in more than 50 countries around the world.