[Congressional Record Volume 140, Number 22 (Thursday, March 3, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 3, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                    A NEW ROLE FOR URBAN HEALTH CARE

                                 ______


                        HON. THOMAS M. FOGLIETTA

                            of pennsylvania

                    in the house of representatives

                        Thursday, March 3, 1994

  Mr. FOGLIETTA. Mr. Speaker, I rise today to call attention to a 
recent editorial in the Philadelphia Inquirer. This very insightful 
editorial written by my friend Iqbal Paroo, president of Hahnemann 
University, articulates the mission that all urban health care 
professionals must promote--efficient, accessible, and affordable 
health care delivery to adequately serve the needs of their urban 
neighbors. As we debate the reform of our health care system, we must 
work together to change the traditional roles of urban health care 
professionals. We must move health care delivery, research, and 
education out of institutions and into our neighborhoods and 
communities to truly benefit residents of urban America. I wish to 
enter this article in the Congressional Record so that others may be 
made aware of the ever-changing roles our health care system must play 
in serving our communities.

                    [From the Philadelphia Inquirer]

    Philadelphia Has Lots of Doctors, But Far Too Many Infant Deaths

                          (By Iqbal F. Paroo)

       This is a time of unprecedented change in the health-care 
     market, as medical institutions merge and Congress debates 
     plans for national health insurance. For many individuals and 
     groups, the changes are discomfiting--especially in 
     Philadelphia, where health care is a highly sophisticated 
     cornerstone for the region's economy.
       We have six medical schools, 37 hospitals, more than 7,000 
     physicians, 49,000 nurses and thousands of associated health-
     care professionals within our city limits--a greater 
     concentration than most places in the United States. And 
     there are 4,260 medical students and 2,400 nursing students 
     in training in Philadelphia and the five-county surrounding 
     area.
       It is understandable, then, that one of the recent themes 
     in public discussions on health care in Philadelphia is a 
     fear of change and a preoccupation with hospital mergers, 
     downsizing and closings. Rather than focus on how health-care 
     institutions are configured, we should ask whether they 
     respond to community needs. Responsiveness and relevance to 
     the community should be the true test of viability.
       To be responsive, Philadelphia's health-care institutions 
     must help make health care more efficient and less 
     expensive--and more accessible. That will require caring for 
     people outside traditional hospital settings, as well as a 
     greater appropriate reliance on well-trained allied health-
     care professionals.
       Today, Philadelphia has 450 doctors per 100,000 people, 
     almost double the national average, and about 300 acute 
     hospital beds per 100,000 people, though many health-care 
     analysts believe only 200 are needed.
       The obvious implication? Philadelphia needs fewer inpatient 
     hospital beds, and may require fewer medical schools and 
     fewer training programs for specialists and subspecialists.
       Clearly then, change will occur. Some institutions will 
     merge or refocus their energies and others will downsize or 
     close. Our choice is whether that change will be chaotic or 
     orderly. Will we let the marketplace arbitrarily decide which 
     institutions live and die, regardless of the impact on the 
     surrounding community? Or will we accept responsibility for 
     carefully planning the changes and for assuring that the 
     community's health needs are efficiently met?
       Several area institutions have taken the latter course. 
     Thomas Jefferson and Pennsylvania hospitals in Center City; 
     Sacred Heart and Suburban General hospitals in Norristown; 
     and my own institution, Hahnemann University, and the 
     Allegheny Health, Education and Research Foundation have all 
     decided to consolidate operations, to one degree or another. 
     Most recently, the Graduate Health System and Independence 
     Blue Cross announced a planned merger.
       These ``partnerships'' should reduce costly duplication in 
     health-care delivery, medical and health-care education, and 
     research. They should also create new opportunities for 
     community education and for neighborhood-based clinical 
     programs.
       Hahnemann's relationship with Alleghany will enable us to 
     pursue two of our long-standing goals. The first is 
     establishment of a Philadelphia-based School of Public 
     Health. This school, the only one in the region, would 
     provide Philadelphia with centralized educational, clinical 
     and research leadership in the field of urban health, an 
     aspect of our health-care delivery system that is sorely 
     lacking. The second goal is creation of formal relationships 
     with the businesses and schools in our communities, enabling 
     us to be more directly involved in our communities' economic, 
     cultural and educational programs.
       Make no mistake, structural change of our health-care 
     institutions cannot be an end unto itself. It is justified 
     only if Philadelphians receive better health care as a 
     result. Unfortunately, there is plenty of room for 
     improvement there. According to the most recent statistics, 
     Philadelphians die at a rate of 727 per 100,000 people 
     compared to the national rate of 523. And our infant 
     mortality rate is double that in the nation as a whole.
       Why? Cities complicate illness and complicate care, and too 
     few health-care professionals fully understand how to deal 
     with complications unique to urban settings. Urban health-
     care requires insights and skills beyond those taught 
     during most health professionals' training.
       The emergence and spread of disease in cities often does 
     not follow textbook descriptions. In urban areas, a 
     ``manageable'' illness quickly becomes serious and, too 
     frequently, leads to death. For example, asthma--
     theoretically easy to treat--causes more hospitalization than 
     any other common medical problem among urban children, 
     because it is virtually impossible to separate the children 
     from exposure to conditions that trigger asthmatic attacks.
       To address urban needs effectively, we must fundamentally 
     change the way we educate the professionals providing health 
     care to urban residents. If we do not, we may find our 
     health-care practitioners in the next decade still lacking 
     the knowledge necessary to improve our city's health.
       Philadelphia and the nation need a new generation of 
     health-care professionals prepared to work with urban 
     residents and to address environmental and cultural factors 
     as elements of total patient care.
       To be able to relate most effectively to their patients, 
     these urban health professionals should reflect and respond 
     to the diversity of our city's population. To understand 
     their patients' environment, they should be educated 
     primarily where health care need first arises--in homes, 
     elementary schools, inner city and neighborhood clinics, and 
     emergency rooms. To assure that their patients receive 
     comprehensive and appropriate care, they must study and work 
     in teams that include physicians, nurses, social workers, 
     physician assistants, counselors, linguists, nutritionists 
     and ethicists.
       Clearly, urban health is no longer simply a function of how 
     many hospitals and medical schools there are and who runs 
     them. On their own, traditionally-configured institutions 
     cannot meet the extensive training needs of future health-
     care professionals--especially the urban health professional. 
     We are entering an era when health-care delivery, research 
     and education increasingly must move out of the institution 
     and into the community.

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