Medicare chief is encouraged about welfare-reform prospects

President Reagan may soon agree to a reform in the welfare system that will remove one of the major disincentives facing recipients who want to work their way off welfare, says Dr. William Roper, one of America's top health officials. If approved, the change would let these adults, primarily mothers with young children, retain some of their medicaid benefits, at least for a while, after they begin to work. Welfare mothers now lose medicaid benefits for themselves and their children when they get a job.

The federal government is also putting a stronger emphasis on the quality of care that Americans receive when Uncle Sam pays their health bills, he says. And Americans realize that.

These points emerge from an interview with Dr. Roper, who heads the federal government's Health Care Financing Administration. This agency, part of the Department of Health and Human Resources, is in charge of medicare and medicaid, the medical programs to aid the elderly and the poor, respectively.

Roper, a quiet-spoken physician, says that one of the accomplishments of his first seven months on the job is to have ``gotten people to take seriously our concerns about the quality of care in the medicare and medicaid programs.'' By both regulation and publicity, he is trying to keep the quality of care up, and to enhance it.

Roper says the President is in the final stages of considering what stance to take on welfare reform. As a base Mr. Reagan has the proposals of White House official Charles Hobbs. He recommends some five years of state and local experimentation with different welfare-reform proposals, provided they meet broad federal guidelines. Until the conclusion of these experiments, Mr. Hobbs says, the government should not recommend major welfare-policy reforms, on grounds that not enough is known about which reforms work.

Many liberal and conservative critics of the current welfare program hold that some way should be found to permit beneficiaries to retain, as they try to work their way off the program, a portion of the medicaid benefits they and their children receive while on welfare.

Roper says various options would be possible and adds that he expects some incentives to emerge from current White House consideration that would aid people in moving off welfare.

Changing medicaid would be complicated, however. It is usually spoken of as one program. Actually, it is 56 programs, with Washington in separate partnership with each state and territory.

Among other progress in his seven months in office, Roper says his agency has regained momentum. Before he arrived, it had been drifting, with several top positions unfilled. He says he is pleased, too, with recent changes in the way Americans pay for health-care services. He notes that three years ago major steps were taken to stem the mounting expenses of medicare, the nation's program of health care for the elderly.

A year ago, he adds, medicare began offering the option of enrolling in certain private health-care plans, with the government picking up a share of the cost. Roper says this option ``makes sense medically, economically, and from the consumer's standpoint.'' The government has less paper work, and the individual can choose the private insurance plan he prefers. Or he can remain in medicare. Some 800,000 Americans have signed up for this alternative.

Roper also considers it appropriate that hospitals now discharge patients earlier than in previous years. This sometimes controversial change in policy is expensive for the financially embattled medicare system. Patients spend more of their recuperative time at home, or in nursing facilities. ``On balance,'' this policy is working well, he says, without harming patients, although ``regrettably'' that occasionally happens.

Roper says he thinks ``America's health-care system is the finest in the world,'' but that his agency plans several steps to improve the quality of care still further. Perhaps most important, his agency is trying to devise a way to rate patient care objectively. Once such a system exists, he intends to rate the quality of health care that professionals and facilities provide and make the ratings public, probably annually.

``We believe,'' Roper says, ``that in a competitive health-care system ... people will choose ... quality'' and that it will serve as an incentive for improvement.

Over the past two decades one of the most criticized elements of American health care has been nursing homes. Roper agrees with most experts when he says that ``in general, we have made extraordinary strides in this country to improve the quality of nursing homes ... [but] we still have some bad apples.''

His agency is in the midst of changing its emphasis on regulating nursing homes, so focus is put on ``true quality of care that patients receive.'' In the past much attention has been devoted to paper work and buildings. Many responsible nursing-home administrators have voiced support for the new emphasis.

Nursing homes, Roper says, play an important role in the American system of medical care. ``The challenge to us,'' he says, ``is to make them decent places to live,'' where patients ``can get the care they need.''

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