Page 2 - Executive Summary BC II - final

6. Increasing older population that is getting poorer

• Older population is getting larger - with fixed or decreasing incomes
• Use services a lot. Greatest portion of medical expenses happen in the last six months of life

7. Issues with navigating the system and adequately informing the public about available services

• Public doesn't know what's out there
• Transportation challenges
• Under informed on hospice

• Even informed people have trouble navigating the system - need an advocate
• Some resistance by doctors to refer to hospice
• Problems with language and culture
• Slow payment by Medicare and insurance providers

8. Highest incidence of medical expenses happen in the last six months of life

• Problem of making care decisions in that time frame
• Lack of living wills and health care directives
• Need to get information to the key medical people
• Nursing homes have to go on the MOLST (Medical Orders for Life Sustaining Treatment)
• Often advance directives don't get to the people when needed the most

9. No one is overseeing the medical community

• There is quality control, but....
• No one oversees the system - too much of a patchwork system

• Need greater coordination of care
• Too much ordering of tests

The Top Ten Rural Issues for Health Care Reform - from the Center for Rural Affairs

Attendees were broken up into pairs, with each pair provided with a rural issue, including a narrative
description from the Center for Rural Affairs, and other information on the topic developed by the committee.
Each pair was asked to read the issue and related information and determine whether and how the issue relates
to Southern Maryland. We ended up with nine issues addressed. Responses were as follows:

1. An economy based on self-employment and small businesses

• In Southern Maryland we really have four big employers - the hospitals, the nuclear power plant, the
school systems, and Pax River Navy base and their related contractors. So this concept really does not
fit us. Plus a substantial part of the population commutes to Prince Georges County (e.g. Census Dept in
Suitland and many others) or even to DC or Virginia.
• But the many small businesses that are in our area struggle with the expense of health care insurance.

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