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This program works, so gut it?

June 21, 2007

June 21, 2007
(c) Boston Globe 2007 Globe Newspaper Company

HEALTH OFFICIALS agree that the best and least costly way to treat diabetes is to manage it vigorously - to avoid trouble in the future by helping patients with monitoring, diet, exercise, and counseling now. When this occurs in combination with home visits by community health workers, the formula can prevent the kidney failure, blindness, and other severe consequences of untreated diabetes that leave patients disabled and generate hefty hospital bills. So why are legislators and the Patrick administration likely to slah a $2.6 million program for community health centers that provides these services to low-income patients?

It is a question that deserves better answers than have been provided so far. Dr. JudyAnn Bigby, secretary of health and human services, refers to the difficult choices required by the overall budget crunch. The administration's budget included just $400,000 for the CenterCare program and folded it into a broader account for community health centers. The House budget cuts CenterCare to $557,000 and the Senate provides $1 million in a consolidated health center account.

Both Bigby and state Senator Steven C. Panagiotakos, chairman of the Ways and Means, hold out the hope that some of CenterCare's 5,000 patients will no longer need its services for chronic conditions including hypertension, depression, asthma, and cardiovascular disease after they become included in the state's new system of insurance coverage for all. But it requires a considerable leap of faith that all insurers in the state's new system will quickly find an efficient way to do what CenterCare is already doing.

Frances Anthes, president of the Family Health Center of Worcester, said the program at her center provides activities in English and Spanish and funds passes for patients to exercise at the local YMCA and YWCA. With this kind of program, she said, community health centers can take a comprehensive approach to health care and provide it at a lower cost. She doubts that many private insurers in the state plan could match these services right away. "I could be wrong," she said.

More likely she is right. Zoila Torres Feldman, president of the Great Brook Valley Health Center in Worcester, said the loss of CenterCare money would be devastating for her center. As for programs by private insurers to replicate the services, including interpreters, that CenterCare now funds, she said, "This is not going to turn around in the first year."

The state's health reform law is a bold experiment in providing health insurance for all. But it should follow the medical profession's rule of "First, do no harm." By underfunding the health centers and counting too optimistically on what insurers will provide, the state runs the risk of doing harm to the Commonwealth's vulnerable patients.