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Subcommittee
On
Health Care

Primary Care Access

Issue 20: How can the state improve access to primary health care?

This Subcommittee focused on the role of primary and preventive health care services in Louisiana. The Subcommittee entertained recommendations by the Department of Health and Hospitals (DHH), Louisiana State University Health Sciences Center, Health Care Services Division (HCSD) and various stakeholders on advancing the current structure for the provision of health care services.

Louisiana currently ranks 49^th in the nation in overall health (Health Care State Rankings 2000 by Morgan Quitno Press). Louisiana’s poor standing in areas such as healthy birth rates, mortality, access to health care services and facilities, statewide (personal and public) expenditures on health care, disease, lifestyle, and disability led to this ranking. At the heart of this issue is the approximately 22 percent of the State’s population that is uninsured.

Budget stabilization is key in setting the course for the future provision of public medical services in Louisiana. Currently, planning efforts on this front are not adequately addressing the state’s long term needs.

In the Medicaid program, current expenditure projections for FY 01 forecast a $64.3 million deficit. Further compounding the problem is an Executive Order directing DHH to reduce State General Fund expenditures by $11.6 million. When matching federal funds are taken into account, this results in a total cut of $39 million. Thus, DHH has a total projected operating expenditure deficit of $103 million ($30 million State General Fund) with only three and one-half months remaining in the fiscal year to address the problem. DHH’s options to resolve this situation are as follows:

Utilize creative financing methodologies. DHH could add non-recurring revenues such as overcollections or excess statutory dedications generated in prior years to offset the deficit in state matching funds.

Push the payment of claims for services provided in FY 01 into FY 02 once the state matching funds are exhausted. The claims will have to be paid in the next year, however.

Implement deep programmatic cuts. Such a move would possibly limit access to vital services for the state’s most needy citizens. For example, the DHH could suspend discretionary medical services for the remainder of the fiscal year.

Combine any of these options.

Furthermore, the forecast for next fiscal year does not improve. As recommended in the Executive Budget for FY 02, the Medicaid program is under-funded by a minimum of $300 million ($88.9 million State General Fund) based on current expenditure and utilization trends. The outlook does not improve in future years. The U.S. Department of Health and Human Services projects health care expenditures to double in the next decade.

The state’s public health care institutions suffer from budget instability as well. The funding level for HCSD is reduced by $77 million ($23.5 million State General Fund) in the FY 02 Executive Budget. Implementing reductions of this magnitude require clear policy decisions on the future role of these facilities in the provision of health care services in Louisiana. Downsizing the budget does not decrease the demand for services proportionately. Further, the operations of the state’s hospital system cannot be quickly restructured.

Any further restructuring of health care service delivery in Louisiana should ensure that adequate access to primary and preventive care is provided. Primary care should be the point of entry into a comprehensive health care system. It is the point at which routine illnesses and injuries are diagnosed and treated. More importantly, it is the point where diagnosis is made and initial treatment begins for more severe illnesses and diseases. Adequate access to primary care, if appropriately pursued, should result in improved health status for both the individual and for a population.

DHH has developed a seven-point plan to address the health care service delivery needs in Louisiana. HCSD has also developed a plan of action for changes to its operational structure to better serve the health care needs of its consumers while maintaining an emphasis on medical education. Various private groups are also developing on-going strategies to reinvent health care in Louisiana.

Staff Suggestions:

At a minimum, the Legislature should consider the following:

The role of local communities in the provision of health care should emphasize the availability of services and providers.

Potential public-private partnerships should be fostered to better coordinate health care service delivery. The cooperative endeavor agreements being negotiated between HCSD facilities and local providers are prime examples of this type of partnership.

New models for the provision of primary and/or preventive care could be explored. Initiatives such as HCSD’s Disease Management program, DHH’s CommunityCare Program, and the Physician Loan Repayment program are exemplary approaches toward ensuring a comprehensive plan of health care in Louisiana.

New funding streams and financing mechanisms must be explored. Implementing these new initiatives may require a re-allocation of the way Louisiana currently funds health care in the state. One option could be the introduction of legislation to statutorily dedicate the proceeds of the Hospital Intergovernmental Transfers Program as match in the Medicaid program.

A renewed emphasis on outcome-based performance measures should be taken in the state’s health care system. Such checks could help ensure that Louisiana is improving the overall health of its citizens.

The Legislature should consider establishing a select committee to assess and to evaluate the state’s public health care service delivery system. Such a committee could present its findings and recommendations to the Legislature prior to the 2002 Regular Session.

Questions and comments may be directed to websen@legis.la.gov.
Baton Rouge, Louisiana.