Improving Health Outcomes in D.C.

Alice M. Rivlin
Alice Rivlin
Alice M. Rivlin Former Brookings Expert

July 14, 2003

The June 30 editorial “A Sick Health Alliance” highlighted fiscal and managerial challenges facing the D.C. Health Care Alliance, the city’s locally funded health care safety net. These problems warrant the mayor’s close attention, as the editorial noted. However, any discussion of the alliance needs to be grounded in the understanding that it is a major improvement in how the District provides health care to low-income residents.

For the first time, the city’s indigent health care system is emphasizing primary care. For the first time, the city’s historical safety-net providers—nonprofit clinics—are receiving regular reimbursement. For the first time, low-income city residents are members of a network that gives them access to specialists, hospitals and prescription medications. This is what the D.C. control board had in mind when it created the alliance.

Of course, maintaining this system depends on strong management by the city’s Department of Health and its contractors. The department must resolve issues, such as high hospital costs, failure to screen out Medicaid-eligible residents from the alliance and a lack of progress in implementing Medicaid waivers.

The city must be held accountable, but we also need to be patient. Some implementation problems in a complex program’s first years are inevitable.

The District, in partnership with others, can and should do more during the next few years to improve the primary-care safety net. It should implement the D.C. Qualified Health Center standards and provide technical assistance to help clinics reach the standards. It should help the clinics find capital funding to renovate and expand facilities, which are often too small, antiquated and not located to meet the greatest need.

In short, the need is not only for better fiscal and managerial oversight. The need is to build on the strengths of the alliance to improve health outcomes for low-income Washington residents. That must be the priority for all parties involved—the mayor, the Department of Health and the city’s health care providers.