Fewer People Than Expected Utilize Privatized D.C. Indigent Health System

In the five months since the Washington, D.C., city government privatized the city's indigent health care system, more than 17,000 low-income residents have enrolled in the new system, short of an expected 25,000, the Washington Post reports (Goldstein, Washington Post, 12/4). In late April, the District's financial control board approved a plan that transferred management of the city's indigent health system from the "bankrupt" Public Benefit Corp. to a private company. The board also approved a plan to phase out inpatient and trauma services at D.C. General, the city's safety-net hospital. Under the new indigent care system, a private company manages a network of more than 20 clinics that contract with private physicians, and Greater Southeast Community Hospital treats patients requiring hospitalization or trauma care (Kaiser Daily Health Policy Report, 5/1). To participate of the new system, called D.C. Healthcare Alliance, District residents must be uninsured, have an annual household income of less than 200% of the federal poverty level and have a home address in D.C. Besides the 17,000 District residents currently enrolled in the Alliance system, another 6,000 had enrolled over the last five months, but were disqualified because their incomes were too high or because they did not live in the District. Those 6,000 people joined other health programs, including Medicaid. Karen Dale, who is in charge of paperwork for the Alliance, said that the overall enrollment figures are below projections because the system has enforced its eligibility rules. In addition, a number of former D.C. General patients were not actually eligible for free care at the facility, meaning that the total number of city residents who qualify for indigent care could be lower than thought, the Post reports. City officials said that many of D.C. General's patients were "Medicaid enrollees who didn't want to bother with their own managed care procedures" or were residents of Prince George's County in Maryland and "were accustomed to using the hospital." Because of lower than expected enrollment, the system has not spent the entire $40.4 million it received from the city, and city officials plan to reallocate more than $15 million to other programs. Francis Smith, executive director of the D.C. financial control board, said he expected the system initially to have "large sums" of unused funds because "advocates exaggerated the number of uninsured." However, City Council member David Catania (R) has launched a review of the system's finances to determine whether the unspent funds mean "contractors are holding back on care." Thus far, auditors have been unable to find evidence supporting that suspicion.

Officials Pleased
The system has encountered some problems setting up, the Post reports. For example, Greater Southeast missed an October deadline to provide trauma care equivalent to the treatment previously available at D.C. General. But city officials said that Greater Southeast will be able to handle trauma patients "within several months." In addition, some of the District's private hospitals said they have picked up the "slack" for treating uninsured patients. Despite those problems and lower-than-expected enrollment, city officials and health care contractors are pleased that "the medical catastrophes" some had predicted would occur with the new system have not happened, the Post reports. On average, more than 11,000 patients have used the system's clinics each month, and there are 30 to 50 patients per day in its hospitals. The Post reports the city plans to offer participation in the system to clinics and other hospitals that "refused to join" when it first began. In addition, Ana Raley, the system's chief executive, said she intends to raise reimbursement rates for providers to attract more specialists, a move that would "eliminate the need" for patients going to Greater Southeast for services such as radiology. Tony Bullock, a spokesperson for Mayor Anthony Williams (D), who pushed the privatization plan, said, "The new system is working remarkably well. All of the dire prophecy from protesters and naysayers and critics simply didn't come true" (Washington Post, 12/4).