Maine officials seek ‘healthiest state’ status

BANGOR – Gov. John Baldacci has said he wants Maine to be the “healthiest state” in the nation, a goal that has shaped a number of state-sponsored initiatives during his terms in office. On Tuesday, two of the governor’s top health officials were in Bangor, hosting an afternoon forum for anyone interested in the state’s pursuit of that goal.

Trish Riley, director of the Governor’s Office of Health Policy and Finance, and Dr. Dora Anne Mills, director of the Maine Center for Disease Control and Prevention, drew a group of about 35 health care executives, public health professionals, municipal health officers and others to the Ramada Inn. It was the third of eight regional meetings scheduled over the next three weeks to exchange information about the state health plan and Maine’s emerging public health system.

In her presentation, Riley told the group that the United States spends almost twice as much on health care as other industrialized nations but lags behind many countries in the overall health of its citizens. New England spends more per capita on health care than the national average, she said, and of the six New England states, only Massachusetts spends more than Maine, perhaps because of the presence of several large teaching and research hospitals.

In 2004, health care spending in Maine reached $8.6 billion and, Riley said, the cost of health care is going up at two to three times the rate of increase in the cost of living.

“The goal is to bring down the growth of health care costs to the same level as our paychecks,” she said, “assuming that most of us get a cost-of-living increase.”

The primary driver of health care spending in Maine is not the cost of individual services, Riley said, but rather the quantity of care consumers demand and receive. For example, the number of emergency room visits in Maine since 1999 is significantly higher than in other New England states. Riley said this is not due to Mainers’ lack of insurance coverage, because Maine actually has almost the lowest rate of uninsured people of all the states. Nor does it reflect a lack of primary care physicians in Maine; only six other states have more primary care physicians per capita than Maine.

According to Riley, Maine’s soaring health care consumption is driven by four interconnected factors:

. Maine’s population is among the oldest in the nation, with a higher-than-average incidence of chromic diseases such as lung disease, heart disease, diabetes and obesity.

. Chronic disorders are not managed as effectively as they could be, resulting in multiple physician visits and hospitalizations.

. An oversupply of expensive new equipment and facilities can motivate providers to order unnecessary tests and procedures in order to pay for them.

. Patients sometimes pressure providers for unneeded procedures, tests and medications.

The biennial state health plan, an outgrowth of Baldacci’s Dirigo Health reforms, aims to counteract these trends. Now in its first comprehensive revision, the health plan seeks to develop a statewide system of health care providers and services that discourages duplication and overuse. The plan also sets quality standards for managing chronic disease and supports community and workplace wellness programs.

Participants at the meeting stressed the importance of accurately assessing regional health care needs, addressing the needs of Maine’s aging population, examining the link between adverse childhood experiences and mental health problems in adults, and reaching out effectively to Maine’s American Indian population.

Mills discussed the state’s developing public health system, which includes a newly created network of eight public health districts. Offices in each district are charged with addressing issues such as diet and exercise, smoking cessation, substance abuse and chronic disease management, and will report to the Maine CDC.

Much of Mills’ presentation focused on the role of Maine’s roughly 400 municipal “local health officers,” whose job descriptions are under review in Augusta as part of the state’s response to both public health and homeland security concerns.

By state law, every town and city in Maine is required to designate a local health officer, but in many cases the designation is assigned to an animal control officer, code enforcement officer or other town employee.

A number of local health officers in attendance expressed concern at a proposal that would mandate specialized education, training and experience for the position, and noted that such requirements could pressure already strapped municipal budgets.

“Everyone seems to agree there needs to be some local [public health] presence,” Mills said after the meeting. The challenge, she said, is in clarifying the job description and integrating local officers formally into the state’s emerging public health system.