What will heal Brooklyn healthcare? Fuggedabout mergers

Long before health planners tried to solve some of Brooklyn's myriad health issues by recently suggesting that Interfaith, Brooklyn and Wyckoff Heights hospitals merge, they commissioned a comprehensive study in 2009 of northern and central Brooklyn's health system. The resulting analysis, released yesterday, provides a framework for regional health care planning in Brooklyn. More significantly, the Brooklyn Healthcare Improvement Project paints a grim picture of health care patterns among an inner-city population.

B-HIP's findings suggest that unless human behavior radically changes, Brooklyn hospital mergers will do nothing to solve the inferior, high-cost health care rampant in three communities with "problematic" utilization: Brownsville/East New York, Crown Heights north/Bedford-Stuyvesant and Bushwick/Stuyvesant Heights.

Researchers documented a widespread, deeply-ingrained preference among patients to head to the emergency room. Patients believe the nicer a building looks on the outside, the better the care. They had little interest in visiting primary care physicians because they are not available after 5:30 p.m. or on weekends. When researchers asked patients in ER waiting rooms why they were there, 43% of those with insurance said they had come for nonemergency reasons. "Primarily, they are coming to the ED for convenience and to circumvent the unavailability of PCPs," said the report.

"Patients want one-stop shopping," said Grace Wong, vice president, managed care and clinical business at SUNY Downstate and B-HIP's principal investigator. "They think they get 'convenience care' in the ER." Ms. Wong said going to the ER is so ingrained that when patients were asked where they would go if that particular ER wasn't an option, 65% said they would go to another ER. Meanwhile, ER physicians said 25% of their cases were not emergencies.

"Just dealing with the system, as in a merger, isn't the issue," said Ms. Wong. "If patient behavior does not change, you don't change anything."

The data in the 60-page report reflects a Herculean effort by researchers, who interviewed nearly 12,000 people. They covered a 22.2-square-mile area with more than one million residents—5% of the state's population—80% of them on Medicaid or Medicare or uninsured.