The Wrong Prescription
Clinic-closing plan sickens county supervisors in their post-King-Harbor convalescence
With his news that the Harbor-UCLA Medical Center is no longer in “immediate jeopardy” of closing, health services director Dr. Bruce Chernof allayed fears that the hospital would be the next King-Harbor, or that another hospital closure would send L.A. County’s health care system headlong into a downward spiral.
But the board of supervisors knows that the county isn’t out of the woods just yet. They still have two looming gaps to close in the coming year: The gap in ER services left by King-Harbor’s demise and the gap in the county budget.
And so the supervisors greeted Chernof’s second order of business at their weekly meeting with a heavy dose of skepticism. He and county CEO William Fujioka submitted a draft proposal to save the county $29 million by privatizing 11 county health clinics, a move that supervisor Yvonne Burke called “penny wise and pound foolish.”
Charged with trimming the county’s budget, Chernof and Fujioka drafted a proposal that not only sought to close the looming budget deficit but to also reshape the model of health care delivery system in Los Angeles County. Their proposal urges a shift to a Private-Public Partnership (PPP) model, in which the nonprofit, private sector shoulders part of the financial burden for health care services that the county now provides.
Chernof and Fujioka insisted repeatedly that this system would provide the same level of coverage – if not more – and that nonprofits are waiting in the wings to enter into such partnerships.
All the supervisors – save Michael Antonovich, who said the recommendations were long overdue – assailed the proposal.
To begin, the actual proposal recommends that the 11 clinics in question be closed. Chernof and Fujioka backtracked and insisted that the word “privatized” be substituted for “closed.” In any case, the supervisors weren’t completely sold on the private sector’s powers to save the county’s budget or its sickly residents.
Supervisor Zev Yaroslavsky suggested Fujioka and Chernof do what they can to avoid cuts to clinics – a “sacred cow.” He called the proposal that would save a mere $29 million in a $4 billion budget “ludicrous.”
Burke agreed: “I know we have to grasp at straws, but this is not the right straw.”
She pointed out the difficulty of securing private funding for largely uninsured populations like those in her district. The crumbling, sub-par clinics that need funding the most are the places it’s hardest to lure private support.
Therese Hughes, a representative from the Venice Family Clinic, said that her clinic provides a good illustration of the pitfalls of relying on individual donors and foundations for funding. The county contributes $94 for every visit. Her clinic must come up with ways to cover the rest of the $134 tab since the private sector fails to serve as the cash cow that some public administrators might imagine.
“For Venice, closing this gap is difficult,” Hughes said. “Philanthropy for primary care is not sexy.”
The proposal is bogged down with other practical issues. Fujioka and Chernof said that they wanted to start putting the proposal into place for 2009.
“With PPP, you can’t do it in a year. It takes a long, long time,” said supervisor Gloria Molina. “It’s not good planning, it doesn’t make sense.”
The supervisors weren’t alone in their skepticism of the proposal’s hasty timeline.
Annie Park with the Community Health Councils warned, “Shifting to the private sector requires careful analysis and planning.”
Abbe Land, co-CEO of L.A. Free Clinic, echoed Park’s comment and expressed concern over how a shift from one model to another could harm the way communities receive their care.
“It is important to make sure that community services are not disrupted,” she said.
Now is not the time or place to look for a quick fix. King-Harbor and Harbor-UCLA have already given us a glimpse of what the spiral down will look like. Slashes to the health department’s budget on the front end will bite us in the back with expensive ER visits, overcrowded ER rooms and longer waits. The answer to the county’s health woes might have to be bold, prescriptive and earth-shattering, but for now, the county bureaucrats could do worse than to get someone on board with them who envisions their charge as more than a budget-slashing exercise.
Once more, boys, and this time with feeling.
Published: 02/20/2008
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I was visiting Harbor-UCLA Medical Center on Wed, Feb 27, 2008 at 10:00 am
The average waiting time which is above 20 hours for non-critical emergency patient made people shouting, desperate and walk home without treatment.