I read with great interest and some dismay the cover story in the Oct. 25 issue, "Rewiring the Rochester experiment: Collaboration vs. competition" (p. 2). The interest was because I was president and chief executive officer of the Rochester Area Hospital Corp. from 1988 to 1992. The dismay was from wondering why Rochester ever departed from the collaborative model.
During my tenure at the RAHC, I saw the collapse of the hospital experimental payment system and the heightened lust for competition. The payment system collapsed for many reasons, but mainly because Rochester hospitals would receive higher reimbursement for Medicare patients if they opted out of the system. So much for regional reimbursement experimentation.
The "Rochester experiment," described in a 1993 U.S. General Accounting Office report aptly titled Rochester's Community Approach Yields Better Access, Lower Costs, was built on:
* A dominant insurer.
* Community rating.
* Active employer involvement.
* Community-based health planning.
In late 1992, after I left Rochester to work in the Canadian healthcare system, I was quoted in a New York Times article as stating that Rochester "is a jewel in a sea of healthcare despair in the U.S." I still believe it was.
My colleagues in health management love the competition model because it shows their effectiveness as managers. But they don't ask if it's good for the entire community.
Competition hasn't done much for our healthcare system except increase the 42 million uninsured by a million a year. For a while competition stabilized healthcare costs, but it did so on the backs of the uninsured. We are all competing for healthy, benefit-rich individuals. Nobody competes for the poor or very ill who lack a group plan.
In short, the "Rochester natives" got myopic. Rochester for many years had one of the lowest rates of uninsured individuals in the country (7% in 1991). What is the percentage of uninsured since the competition model materialized?
A critic of a return to collaboration said, "You can't put the toothpaste back in the tube." Maybe not, but that's what we are trying to do in Flint, Mich. We will keep you informed of our progress.
President and CEO
Greater Flint (Mich.) Health Coalition