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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Health schemes for mom and child show results

The recently launched Janani Suraksha-Shishu Karyakram (JSSK), and mother and child tracking system (MCTS) adopted by the State has begun to show results. Both schemes are aimed at minimizing the infant mortality rate (IMR) and maternal mortality rate (MMR) under National Rural Health Mission (NRHM). Although the central government schemes are implemented by the public health system department of the state.

The JSSK is not a replacement of existing Janani Surakasha Yojna (JSY) that promote institutional deliveries. It is a further arrangement with much broader scope. Under JSY, the benefit was limited to the mother and it is only those who live below the poverty line and SC / ST categories. But JSSK covers every mother and child regardless of income and caste status.

The main advantage of JSSK is that instead of providing any financial support scheme allows free delivery (including caesarean section a) and care to all expectant mother up to 42 days after delivery and free care for the baby for 30 days.

Dr. Manohar Pawar, deputy director of health services (DDHS), Nagpur circle covering Nagpur, Wardha, Gondia, Bhandara, Gadchiroli districts Chandrpaur and told TOI that the scheme very attractive for both rural and urban women, as it allowed not just free diagnosis, studies complimentary therapy, medication and meals during the hospitalization period but also free pick and drop facilities to the patient.

"The pick and drop facility is available round the clock via a call center. Anyone interested in using it to call 102 at district level hospital," said Dr. Pawar. Of course, the vehicle is made available, even at the primary health center as the information passed to the nearest Delivery Center, which could be a PHC, a sub-center or district hospital. We get very good response from patients. If a patient does not use the department vehicle or ambulance, is a fixed fare refunded to the patient, "says Dr. Pawar.

Since Nagpur does not have a district hospital has Daga Memorial Hospital has been chosen. The hospital still does not have the 102-number. "You'll have to call 2729332 for now. The process of moving 102 Number from Nagpur Municipal Corporation (NMC), ambulance service to Daga hospital is on," says Dr. Vaishali Khedikar, hospital superintendent. Actually received Daga two vehicles on Thursday itself.

The second scheme, MCTS, is a relatively mature one, but has just now become popular.As of now, it is limited to only rural areas but will soon be extended to the cities too. The process of training of the staff has already begun. DDHS office claims to have registered an increase in institutional deliveries from 65% in 2005, when the NRHM began to 98% now.

MCTS covering the mother from the day she reports to the registration of pregnancy to 30 days for children and 42 days for mom. This system has computer records of every mother and child, and the data are updated daily across the country. The changes are visible every day at NRHM website (sub-head nrhm-MCTC).

Comprehensive data, including name, address, phone numbers, ANM and Asha workers who treat patients and follow up records maintained for each patient. Immunization of the baby is also maintained. Highest authorities in the health sector can keep watch on employee .

Article source:-http://timesofindia.indiatimes.com/city/nagpur/Health-schemes-for-mom-and-child-show-results/articleshow/11504544.cms

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