Opinion

JOAN VENNOCHI

Reduce cost, not number of poor kids, at Children’s

17hospital - Entrance to Boston Children’s Hospital. (Boston Children’s Hospital)

Boston Children’s Hospital

Boston Children’s Hospital is paving over a beloved garden so it can build a new 11-story building that will provide the highest quality health care to more young patients.

There will be fewer poor ones to treat, though — now that an insurance plan designed for underprivileged families is restricting access to doctors at Children’s.

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As reported by the Globe’s Priyanka Dayal McCluskey, Neighborhood Health Plan — a division of Partners HealthCare — has changed its contract, forcing members on Medicaid to give up their specialists at Children’s, or find a new health plan. Neighborhood officials said they made the change because they can’t afford the rates at Children’s.

Ironic — isn’t it? — that an insurance plan owned by Partners is saying it can’t pay Children’s hospital rates. The Partners provider network is often cited as a key driver of the high per capita health care costs associated with Massachusetts. Now with this decision, Partners is limiting access of its low-income insurance customers because it doesn’t want to pay the high rates demanded by Children’s, the market’s other high-priced giant.

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The policy shift comes at a sensitive time for Children’s, a renowned institution that’s moving forward with a controversial $1.5 billion expansion plan. In a recent Globe op-ed, Sandra L. Fenwick, Children’s president and CEO, described a lofty vision for the new space. It includes a new state-of-the-art neonatal care unit and a new interdisciplinary Heart Center.

“Our plans will benefit everyone who comes to Boston Children’s, but to achieve them, some things need to change,” she wrote.

The change to which Fenwick was referring involves Children’s plan to eliminate the Prouty Garden, a longtime sanctuary for patients and their families, and replace it with new gardens. If eliminating a garden raises value questions for Children’s — as critics contend — so, too, does the issue of reducing the number of poor patients.

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Who will make it to Children’s new health care paradise? Increasingly, only those families with health insurance that covers the cost of being treated there. It’s another tale of two cities, just one more measure of the growing gap between the haves and have-nots in Boston and beyond.

It’s one thing for elite hospitals to provide special treatment to the rich and famous. The Globe recently reported on one such case of “VIP syndrome” involving a patient at Brigham and Women’s Hospital who had ties to Middle Eastern royalty and was coddled to the point where the hospital ditched its health and safety protocols to please him.

That’s outrageous. But to limit a child’s access to the best possible medical care on the basis of income is even more outrageous. As the Globe reported, Neighborhood Health isn’t the only perpetrator of such policy. Tufts Health Plan requires prior authorization before Medicaid members get inpatient treatment at any hospital, and the state’s other three Medicaid-managed care plans don’t include Children’s in their networks.

To be fair, Children’s does provide care to children on Medicaid and, according to hospital executives, loses at least $100 million a year because not all costs are reimbursed.

Also, in this case, it is Neighborhood Health Plan that is redirecting patients from Children’s, not Children’s saying they won’t treat them. In doing so, the Partners-owned Neighborhood Health Plan is enforcing cost-cutting policies that mean poor children can’t get care at one of the world’s most distinguished hospitals. Instead, they are being shifted to other lower-cost providers — and Children’s is going along with it.

Why can’t Partners and Children’s instead get behind an effort to lower their rates? The goal should be greater parity for all in health care — not less.

Joan Vennochi can be reached at vennochi@globe.com. Follow her on Twitter @Joan_Vennochi.
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