The Maryland Experience and a Practical Proposal to Expand Existing Models in Ambulatory Primary Care

W. Anthony Riley, Walter A. Schneckenburger

Research output: Contribution to journalArticle


Two unique models for caring for the uninsured and underinsured are operating in Maryland. The first is a group practice, primary care model with a unique ambulatory Medicare waiver that has had a positive impact on patients and physicians. The second is a financial model—an all-payer prospective rate-setting system for all critical care inpatient hospitals that, during a 13-year period from 1977 through 1989, has saved the citizens of the state approximately $5.361 billion, has allowed hospitals to provide $1.657 billion of charity care and bad debts, and has earned $517 million in net profits. The reasons for the success of each of the models are discussed and form the basis for a practical and politically feasible proposal: merge the best aspects of each model into an ambulatory primary care—based model financed through an all-payer prospective charge system.

Original languageEnglish (US)
Pages (from-to)1118-1122
Number of pages5
JournalJournal of the American Medical Association
Issue number8
Publication statusPublished - Aug 28 1991


ASJC Scopus subject areas

  • Medicine(all)

Cite this