Health Industry Proves Effective, but Proper Care Still Evades Many

Article excerpt

More physicians and dentists are practicing in Oklahoma than ever before. But are the state's residents any healthier than they were before the doctors arrived on the scene?

By several measurements, the answer appears to be yes, despite clear knowledge that health care still lies beyond the reach of thousands. Improving the so-called safety net to catch the unemployed and low income people whose resources exceed the eligibility requirements for Medicaid assistance is seen by some observers as a critical step toward a healthier environment.

Whether action is near on this controversial front hinges largely on the outcome of a major study here by the state's Council of Health Care Delivery as well as congressional debate on legislation intended to shore up the system. Although some members of Congress favor a move to mandate health care insurance coverage by the largest employers, and offer government-backed coverage to the unemployed, the safety net gap is likely to remain untouched until a new administration moves into the White House.

Certain recommendations are expected from the state council in the fall, and the Legislature may be asked to intervene long before the federal government gets around to dealing with the issue. It is, however, a national issue.

More than 37 million people are believed to be without health care coverage. In Oklahoma, the evidence indicates that at least a quarter of the state's population is without coverage.

Hospitals here and elsewhere accept a certain level of non-paying, or charity, patients, a practice that partially eases the burden for the uninsured.

Records show, however, that fewer and fewer people re going to Oklahoma's hospitals for treatment. Over the last several years, the number of patient days has dropped by 23 percent, and the number of occupied beds has fallen even more dramatically - from 61 percent in 1982 to 46 percent in 1986, according to state officials. The state has 130 acute care hospitals.

Through much of the same period, the supply of physicians rapidly outpaced population growth. Between 1975 and 1980, the state's population rose by 11.4 percent. At the same time, the number of doctors - MDs as well as osteopathic physicians - increased 27.3 percent.

While there are obvious benefits, health care experts say, the growth in the supply of doctors does affect spending levels. But those who measure health manpower levels now expect the rapid rise to stop and possibly decelerate in the next decade, a trend that would ensure lower inflationary pressures.

The supply of dentists, which are also part of the health care equation, has risen from 42.8 per 100,000 of population to 46.6 dentists per 100,000.

The principal problem, however, is maldistribution among both dentists and physicians - large numbers concentrated in urban areas, too few in rural counties. Moreover, the state suffers from a shortage of nursing personnel. Enrollments in baccalaureate nursing degree programs have declined in recent years.

Structural changes notwithstanding, there are signs that important public health gains are being made in Oklahoma.

Fewer births are being recorded, but the rate of infant mortality, watched carefully by health authorities around the world as a reliable barometer of society's general health, has begun to show improvement here. …