The Right Health Choice for the District

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

April 15, 2001

The D.C. financial control board strongly supports Mayor Anthony Williams’s plan to contract with Greater Southeast Community Hospital and its partners to provide health services for D.C. residents who lack health insurance or adequate resources to pay for health care.

This plan is controversial because it involves closing the inpatient facility at D.C. General Hospital and purchasing patient care services from private providers monitored by the D.C. department of health. The control board believes that this plan will substantially improve health care available to uninsured D.C. residents and ultimately make this population healthier.

The crisis at D.C. General Hospital has been a long time in the making. Washington’s public hospital experienced shrinking utilization as the District’s population declined. Doctors substituted outpatient care for hospitalization and low-income residents, increasingly covered by Medicaid, sought treatment elsewhere. Meanwhile, D.C. General, overstaffed and poorly managed, overspent its public subsidy year after year. Timid politicians, unwilling to face the wrath of hospital employees, kept the hospital open and passed the bill on to taxpayers.

The Public Benefit Corp. (PBC), which runs D.C. General, masked the financial losses by calling uncollectable bills “receivables” until auditors lowered the boom and declared the PBC effectively bankrupt. It had spent its entire budget in the first half of this fiscal year. Despite the efforts of many dedicated and caring staff, the PBC has failed the population it was created to serve. It never tied its hospital and clinics into an integrated system. Doctors treating patients in the clinics often could not get them admitted to the hospital, and patient records were not transferable from clinic to hospital. Patients without access to primary or preventive care crowded the emergency room, often waiting too long to seek treatment.

To address this crisis, the D.C. Council, the mayor, the control board and the District’s chief financial officer formed a “health care collaborative,” which sought partners to help the District build a strong health care system for the uninsured. Proposals were invited and carefully evaluated. The group led by Greater Southeast Community Hospital presented by far the most comprehensive and well-structured plan. The control board conducted a thorough negotiation with Greater Southeast and its partners to make sure they had the capacity to deliver the required services and would work together effectively. After reviewing the evidence, the control board will recommend to the mayor that he approve the proposed contract.

Greater Southeast has already revitalized the previously troubled hospital for which it is named and is running it well. Its partners in the new plan, Unity Health Care and the Chartered Health Plan, are established providers of health services to the low-income population of the city. Together they will offer the uninsured population access to a broad network of experienced providers, both primary care practitioners and specialists. They will also maintain the existing PBC clinics. They plan extensive outreach to encourage potential patients to seek primary and preventive care, and not wait until they have no option but the emergency room. Participation of Children’s National Medical Center and George Washington University Hospital gives added assurance that the District’s most vulnerable population will receive quality care.

In contrast to the chaotic record-keeping that has plagued the PBC, the new plan offers a modern information system that will process financial and medical records quickly and accurately. By closing the small, high-cost inpatient facility at D.C. General—while keeping the clinics and emergency room there open—the plan will be able to deliver more care to more patients without exceeding the budget. Indeed, a cushion has been built in that would allow the new network to increase services by as much as 30 percent. Both uninsured residents and the city’s taxpayers will benefit from having a fiscally sound and competently managed plan.

The mayor, the council, the control board and the chief financial officer all participated in last year’s review of proposals offered to address the city’s health crisis and improve service to the low-income uninsured. The council still has deep concerns about relying on private sector providers and remains committed to keeping the public hospital operating.

Nevertheless, the plan led by Greater Southeast was by far the strongest plan submitted. In fact, there is no viable alternative on the table. D.C. General and the PBC deserve recognition and deep appreciation for so many years of devoted service. Yet the hallmark of any jurisdiction’s ability to govern itself is the capacity to recognize when needs have changed and make the required hard decisions, even in the face of strong political opposition from those with vested interests in the status quo.

We are confident that the mayor’s plan is the right decision for the District. We are fully committed to making it a reality.