Defining, funding quality healthcare for the poor

AS THE nation looks to Massachusetts as a model for healthcare reform, decision makers must keep in mind that the most vulnerable patients often cannot advocate for themselves. As pediatric residents at Boston Medical Center and Children's Hospital Boston, we see the promise of exceptional healthcare. Yet we are concerned that funding decisions being made now will adversely affect the promise of healthcare reform for poor children and their families.

Quality healthcare requires health insurance that provides equitable reimbursement. Unfortunately, not all hospitals and providers are reimbursed fairly for the services they provide. Based on current rates and incorporating proposed cuts for next year, the governor's proposed budget would reimburse BMC only 64 cents for every dollar it costs the hospital to deliver care to our predominantly low-income Medicaid patients.

No healthcare provider can remain viable, much less continue to provide excellent care, while being paid 64 cents for every dollar spent. The White House recently announced that $15 billion in immediate Medicaid relief from the stimulus bill is being sent to the states. The money is federal matching funds given annually to states to pay for Medicaid and other related expenditures.

Fortunately, Massachusetts will be getting approximately $3 billion over the next two years and more than $594 million of that is expected soon. The money should be used as an immediate remedy to restore equal Medicaid reimbursement so that vulnerable patients at hospitals like BMC can continue to receive the services they desperately need.

According to a 2008 report issued by the Boston Public Health Commission, the neighborhoods in which our patients live have some of the highest rates of low birth weight babies, asthma hospitalizations for children under the age of 5, tuberculosis, substance abuse treatment hospitalizations, infant mortality, and overall mortality.

For these patients, quality healthcare means that the smallest premature baby, weighing less than a pound at birth and requiring life support to survive, will receive cutting-edge care in BMC's neonatal intensive care unit and will one day come back to visit the doctors and nurses who cared for him or her as a mischievous, energetic 2-year-old.

Quality healthcare means that when a parent brings a child for a well visit, the youngster will receive vaccines and other routine care, as well as a book to take home to prevent future learning problems. And the family will receive food from BMC's food pantry to prevent malnutrition and free legal assistance to prevent them from being evicted or having their power shut off.

Quality healthcare means that a teenager suffering from a severe asthma attack will be treated aggressively in our pediatric emergency room and will be cared for by critical care specialists in the pediatric intensive care unit, and will walk out of the hospital able to breathe again.

Our patients, who carry such an unequal burden of disease, desperately need the unique, high-quality medical services that BMC offers. But if BMC does not receive fair Medicaid reimbursement, we cannot continue to provide our complicated and vulnerable patients with the services they deserve. Simply carrying an insurance card does not guarantee good healthcare. BMC requires equitable funding if it is to continue to deliver high quality, comprehensive medical services to our patients.

As President Obama seeks to reform the healthcare system he is looking to Massachusetts. Our state now leads the country in expanding coverage. We must also continue to lead in providing the best care to patients living in poverty. The Patrick administration can increase Medicaid rates to a fair and reasonable amount. This needs to be done soon. The nation is watching.

Dr. Genevieve Preer and Dr. Chén Kenyon are senior pediatric residents at Boston Medical Center and Children's Hospital Boston.