Monday, October 16, 2006

Post-Katrina New Orleans: The coming health care crisis?

Breath MobileI continue to take stock of what I learned over the weekend from Tulane's symposium on the legal landscape of the Gulf South after Katrina. I am thinking in particular of the keynote address by Walter Issacson, vice-chairman of the Louisiana Recovery Authority. When asked to name his three biggest priorities for during the reconstruction, Mr. Isaacson mentioned levees, schools, and housing.

In retrospect I wish he had also mentioned health care.

Though their article is now six months old, Ruth E. Berggren & Tyler J. Curiel, After the Storm -- Health Care Infrastructure in Post-Katrina New Orleans, 354 New Engl. J. Med. 1549-155( April 13, 2006) remains essential reading. Berggren and Curiel's observations still ring true because their four basic findings still apply to greater New Orleans, more than a year after the storm:
  1. New Orleans, which was short on hospital beds relative to other cities before Katrina, has yet to regain half beds. Crucial health care facilities simply remain closed. Many services are being delivered in trailers, converted recreational vehicles, and other patchwork facilities. The area's population has fallen, to be sure. But New Orleans does survive, and hospitals that are closed serve no one.

  2. Many area physicians left after Katrina, having lost housing, schooling, and/or spousal employment. Many of these physicians have not come back.

  3. The influx of transients, drawn by employment related to the reconstruction effort, puts pressure on the area's compromised health care system. Health care in New Orleans has always had to deal with the area's disproportionate share of indigent, uninsured patients. Now the city and its surrounding parishes have even more patients of this sort.

  4. Independent of personnel, the health care demands of greater New Orleans have skyrocketed, as one might expect of an area that bore the brunt of the greatest natural disaster in American history.
Some sort of health care crisis is bound to strike New Orleans. As a nation, we can only hope that the response to that crisis will be more effective than the response to the storm itself.


Anonymous Scott Needle MD said...

Long-term health care recovery and planning has been utterly absent since the day Katrina hit the Gulf Coast ; here we are one year later and a few officials are just starting to even think about it. Unfortunately, I have little hope that anything (let alone something constructive or practical) will happen or change at this point. As an example, Michael Leavitt has directed the Louisiana Health Care Redesign Collaborative to find a way to fix New Orleans health care, while remaining REVENUE NEUTRAL. WHAT revenue? And what about the millions (billions?) of losses?

My interest in this area comes from my being a pediatrician in Bay St Louis, on the MS Gulf Coast. The MS situtation was and is somewhat different from New Orleans , but the official response has still been the same (i.e., neglect and avoidance). I've tried to talk to various officials and other parties but have received only shrugs. You ask if we as a nation will be able to respond to a health care crisis in New Orleans : the answer is a resounding no, since (1) N.O. IS currently in a health care crisis, with still no response, and (2) we as a nation (e.g., public health
services, private sector, etc.) have not seemed to learned anything yet.

We should be ashamed: first, we need to acknowledge the shortcomings of this employer-based health-care-is-a-privilege-not-a-right system; second, break down the artificial barriers between public and private providers (especially in a post-disaster environment when the lines do disappear), third, realize that the goal of a health care recovery should be a linking patients with services and providers on a local and long-standing level (e.g., the "medical home" concept). Finally, the lack of any national
leadership on this issue has been inexcusable. We're doing our best here on the Gulf Coast to take care of ourselves and our patients, but I have no hope for any changes before or after the next disaster.

10/24/2006 11:09 AM  

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