Report confirms need for LA indigent health care overhaul

I was pleased to see the Louisiana State University Daily Reveille had the brainstorm of serving a public records request on its own administration to pry free a copy of the preliminary report by the Public Affairs Research Council that sent LSU system officials into a tizzy. The report is critical of the money-given-to-the-institution system of indigent health care in Louisiana, while promoting the money-follows-the-person reform resisted by Gov. Kathleen Blanco and the state’s vested health care interests.

However, I am disappointed that I received so little credit in the report, as over the past five months in this space much of what was in this report has already appeared (perhaps in the final draft they will cite my postings). PAR in this report drew almost all of the conclusions that I did: shift to money-follows-the-person to improve quality and efficiency of care, centralize medical education in just a few charity hospitals and dispose of the rest to help achieve these savings, and do not build a grandiose new “Big Charity” hospital in New Orleans as it should be there primarily for medical education, not as a charity provider.

The report makes one excellent point of which I was unaware. Despite medical education of some form occurring in most of the charity system’s units, the report indicates that often these hospitals are behind the times in treatments in many differing areas. Perhaps this is why their outcomes tend to be no better, and are often worse, than nearby non-government institutions. It indicates how a restructuring of medical education could be used to generate more federal dollars for the state in this area.

However, I would quibble with the plan’s report to consolidate medical education in just New Orleans, Baton Rouge, and Shreveport. The last is a great idea, and the first too if the smaller hospital is completed (which would still be roughly the size of Shreveport’s). But putting education functions in Baton Rouge would necessitate a much more expensive facility than the existing aging Earl K. Long complex, a hospital at this time which provides relatively little medical education. While having the LSU system and state government near by, it might make more sense to take education out to other facilities more comprehensively covering the state such as E. A. Conway in Monroe (near the state’s premier pharmacy program) and perhaps to move rural medicine there, and put some other programs at University Medical in Lafayette.

However, the report makes an excellent case for ridding the state of its present less efficient, less effective indigent care system, and replacing it with a system that gives greater choice to its users in the long run for less money and better outcomes. Regardless of what citations appear in the final version, let’s hope it comes out about the same as this one.