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Monday, April 9, 2012

Columbia Medical Plan Development

        This week I hope to share some local history of Howard County and Columbia.  I have been spending some time at the Columbia Archives and the Howard County Historical Society.  Today some background to the health care system that many of us joined when we moved to Columbia---the Columbia Medical Plan.

         In the 1960's, when the planning for Columbia was starting, a new health care delivery system called a Health Maintenance Organization (HMO) was beginning.  The earliest HMO systems had been developed in California with the Kaiser system and in Boston with the Harvard Community Health Plan.  HMO's stressed preventative health and hoped to move away from an illness based fee for service system.  Dental care, mental health and vision care were included in the HMO plans.  Columbia planners worked with Johns Hopkins Community Research and Development to do the planning for the development of a HMO group medical practice on a prepaid basis for Columbia residents.

       Mike Spear in a memo to Jim Rouse identified "the major problem in providing adequate health care in America is not so much a question of adequate medical resources as of accessibility to those resources.  The major challenge in providing adequate health care in America is devising systems that guarantees accessibility for individuals of all ages and incomes."

       The planners of Columbia were particularly focused on not having Columbia be segregated by race and income. The stated goal was "to encourage and promote arrangements for opening opportunities for low income groups to move into and become self-sustaining residents of the new town area including provision for education, training, career development, purchase of housing and sufficient low rental units."

      An early controversy arose in the planning of a hospital for Columbia that was to be only open to doctors with the Columbia Medical Plan.  This conflicted with the plans that a group in Ellicott City had with their efforts to have a hospital built on land that had been donated by Charles Miller.  Knowing that only one hospital would be approved for Howard County, having County residents that were not members of the Columbia Medical Plan excluded from being admitted to a local hospital was a problem.  This played into the resentments of many older Howard County residents that Columbia was exclusive.  Eventually both groups realized that they had to find a compromise to get a hospital in the County and the admitting privileges was expanded to non Medical Plan members.

New edition of the Homeless Gazette.  Interesting reading


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