In the 1960s and ’70s, community organizations in Boston pressed the major teaching hospitals to use their prodigious resources to improve the health of low-income residents in our neighborhoods, and the hospitals agreed to sponsor health initiatives around the city. Boston Children’s Hospital agreed to provide financial support to the Martha Eliot Health Center (MEHC) in Jackson Square, which it has been doing for over 40 years. Unfortunately, Children’s has announced that it plans to back away from that commitment and terminate care for adults at MEHC. The laying off of the director of community services at the health center also suggests that Children’s may be planning to defund important community health programs there.
Why has Children’s decided to cut back on services at MEHC? It says it wants to do what it is best at, which is to provide child and maternal health services. But community health centers can, and often do, rely on the expertise of multiple institutions. In fact, MEHC has been partnering with Brigham and Women’s Hospital since the 1970s for adult health needs, including for specialty referrals and hospitalizations, and this arrangement has worked very well for MEHC’s adult population.
Children’s has also expressed concerns about how well adult patients will be cared for under a new way of organizing health care and insurance coverage, the proposed accountable care organizations (ACOs). But there are no theoretical reasons why ACO networks cannot involve providers from multiple institutions. And no current ACOs prevent patients from using whichever providers are the best match for them, no matter where they work. It therefore seems like a case of putting the cart before the horse for Children’s to end services for MEHC’s adult patients because of a theoretical future concern about the way ACOs will behave.
Children’s has said that adult patients at MEHC will have no difficulty finding other places to go for their care. But MEHC currently provides unique community health programs for adults. It also has a staff of providers who understand the cultural and health needs of that population. It is unclear how easily this kind of culturally responsive care will be available elsewhere. At a minimum, Children’s should be able to demonstrate that sufficient services exist elsewhere to care for the 5,000 adult patients at MEHC before it ends care for them.
Just as in the 1960s and ’70s, when community health centers were born out of an understanding that good health care is vital to the well-being of our neighborhoods, our local community health centers still need ongoing financial support from our hospitals to help that happen. The hospitals, which benefit financially from our neighborhoods when its residents become ill, should reasonably be asked to help keep them well. Children’s recent announcement about MEHC is an unfortunate, abrupt retreat from this longstanding commitment and it creates the appearance of putting their own financial interests before the well-being of the greater community.
John Jewett, M.D.
Editor’s Note: The writer was the director of adult medicine at Martha Eliot Health Center from 1992 to 1995.