County Health Overhaul Too Slow, Critics Say : Government: Private care providers charge that restructuring plan lacks specifics. But official says it is moving on the ‘fastest possible track.’
Los Angeles County is not moving fast enough to implement its highly publicized plan to overhaul the public hospital and clinic system, private health care providers complained Friday.
“We were hopeful that the [plan] would actually prescribe a restructured county health care delivery system,†said Jim Lott of the Healthcare Assn. of Southern California, which represents most of the region’s largest hospitals. “Instead it prescribes a development process, without any tangible, specific or immediate†proposals that would prevent a replay of this year’s budget crisis.
The issue surfaced during a hearing conducted by the state Department of Health Services on the county’s plan to restructure its health system as part of a $364-million financial rescue drafted two months ago by county officials, President Clinton and Gov. Pete Wilson.
The plan, at this point, is for the most part a broadly worded statement of principles and objectives.
Clearly some of the local hospital officials who attended the hearing came with the hope that the state would step in and either push the county to move faster or introduce reforms of its own.
But the governor’s health advisors at the hearing said they would let the county continue to take the lead in reshaping its troubled health care system.
“We are working very closely with the county,†said Roberto B. Martinez, a branch chief with the state’s Medi-Cal division. “It will not be an adversarial process.â€
The county, under the restructuring plan, promised to overhaul its health system and impose reforms that would head off future financial crises like the $655-million deficit this year.
The plan calls for partnerships with private providers, a de-emphasis on hospital stays and greater emphasis on outpatient care.
Those at the hearing generally applauded the objectives of the restructuring plan, which was drafted by county health czar Burt Margolin and his staff. But they criticized its lack of detail, and called into question the county’s commitment to working with private and nonprofit health care providers in the restructuring.
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An additional deficit of nearly $200 million for public hospitals and clinics in the upcoming budget year is being predicted, even with the bailout, Lott said.
“That’s just six months away, and we don’t seem to be doing much about it except talking ‘process,’ †he said.
Others expressing concerns included representatives of the Los Angeles County Medical Assn., a group of private nonprofit hospitals that serve the inner-city poor, a network of Catholic hospitals and a spokesman for 20 community clinics.
“The county is doing everything it possibly can to avoid a repetition of the crisis,†Margolin said in response to the criticism. “[The plan] is moving ahead on the fastest possible track.â€
As for concrete steps, he said the Board of Supervisors had appointed a new health care director, Mark Finucane, who will take over in mid-January with explicit instructions to overhaul the system, and had turned over six county clinics to private providers, with plans for more.
Some local hospital administrators and health care providers would like to see the state be more assertive in fashioning the county’s health policy. They say privately that they believe the Board of Supervisors and the powerful health care bureaucracy it oversees will never surrender the power needed to overhaul the health system without outside pressure.
Because the federal money must go through the state, technically the bailout and restructuring plan will be the state’s, and not the county’s, even though the county will get the most benefit. That, in effect, leaves the door wide open for the state to introduce its own cost-cutting and oversight proposals. The county and state have been at odds for years over local health care spending.
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One private hospital executive who asked not to be identified said: “The county is desperate for the money. If the state says, ‘No, we want this, this and this,’ what can the county do? The state has tremendous leverage.â€
But Martinez said it was leverage the state did not want to use, at least now. For one thing, the governor has already agreed to the plan. Martinez also said the state wants to help solve the immediate financial crisis.
“We are certainly allowing [the county] to take the lead,†Martinez said. “We are working with a crisis situation. We are trying to move this as quickly as we can to put something in place for L.A. County.â€
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