Health Enterprise Zones to target disparities in state

Frustrated by Maryland high rate of health inequalities, the state's leaders propose a new attack - more commonly associated with economic development.

Governor Martin O'Malley's 2012-2013 budget will include funds to provide health Enterprise Zones, where doctors and community groups in areas with large health inequalities that Baltimore could add medical and support services to minorities. Tax credits and other financial incentives would be available to spur interest.

The plan is designed to save lives and healthcare dollars, according to Lt. Gov. Anthony G. Brown, who last summer formed a working group on the differences under the direction of Dr. E. Albert Reece, dean of the University of Maryland School of Medicine.

"Maryland has world-class hospitals, top medical schools and one of the highest rates of primary care physicians per capita, yet we continue to see disparities in health care and outcomes among Maryland racial and ethnic communities. It is clear that a lack on access to primary care in many communities is a major factor these differences, "Brown said, adding that funding is in the governor's budget proposal, which has not yet been released.

According to state and national data, the differences are many: In Maryland, the infant mortality among blacks nearly three times greater than for whites, the incidence of new HIV infections among blacks is almost 12 times greater than whites and Hispanics are more than four times as likely not to have health insurance as whites.

Moreover, nearly twice as many African-Americans suffer from diabetes as whites, and hospitalization rates were three times higher for blacks with asthma and 41 / 2 times as high for blacks with hypertension.

Treatment of such diseases is expensive, the working group, which cited data showing nearly 230 billion dollars in direct medical costs could have been saved from 2003 to 2006, if there was any racial and ethnic disparities in health.

The proposed program would work somewhat as economic enterprise zones where businesses receive grants to create jobs and activity in certain areas. The health zones program will be a pilot, available in two or three geographical areas.

New and existing primary care practitioners could receive loan repayment assistance, income, property tax or rent, and help with installation of information on health and other technology. Grants will be capped, probably in the tens of thousands of dollars. Local health departments may be involved in recruiting participants.

Brown said he would push to expand the program statewide if it proves successful in a few years - not certain, given the logistical and cultural complexity of the problems. For example, residents in some neighborhoods do not have easy access to grocery stores that sell fresh fruit and vegetables or not to visit the doctor until there is an emergency.

Reece said many groups have addressed the differences, but the working group wanted to focus on chronic diseases are responsible for 80 percent of health expenditures. They have drilled down to a few important maladies that often have "ripple" effects. They include diabetes, hypertension and asthma.

"We decided to find out ... areas where we thought we could make a real impact within a reasonable timeframe," he said.

The health enterprise zones approach is unique, he said. Working group members got the idea from a similar program built around the needs of children in society to Harlem in New York City.

Program applicants are expected to come predominantly from rural and urban areas where inequalities are most pronounced.

In Baltimore, studies show a 20-year gap in life expectancy between high-income, predominantly white neighborhoods and poor, predominantly minority neighborhoods.

Recently, city Health Department officials began working with local leaders in 55 districts to identify the most pressing health needs and develop plans to address them.

National zones would complement these efforts, Reece said. His work group also suggested other elements that promote health and track results.

Group suggested Health innovation awards with small financial rewards and public recognition for individuals and groups that improve health and wellbeing of their communities. The group also recommended track difference data for programs that already exist for primary care physicians and hospitals. Incentives and penalties assessed by these programs could ultimately be linked to the differences.

Reece said the price, and the enterprise zones are two things Maryland can do now to help reduce disparities in a few key geographic and health areas.

If legislation is to create zones have passed during the current legislative session, will further be developed by the state Department of Health and Mental Hygiene.

Already, Dr. Joshua M. Sharfstein, department secretary, supports the move: "The establishment of Health Enterprise Zones will help communities target resources to have the most powerful effect."

Articale source:-http://www.baltimoresun.com/health/bs-hs-disparities-report-20120116,0,5859254.story

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