Los Angeles County Supervisors to Consider Creating a Public Authority for Troubled Health Department
Los Angeles County's Board of Supervisors on Sept. 4 will hold its "first formal discussion" about creating a public health authority to control the county's health department, as supervisors' long-time "opposition" to such a move has been "softened" by the department's projected $884 million deficit and reports of substandard care in county hospitals, the Los Angeles Times reports. Currently, the health department, which provides care for Los Angeles County's roughly three million uninsured residents through its numerous clinics and six public hospitals, reports to the five-member Board of Supervisors and as a result is a "highly politicized institution." The county hospitals "operate as virtually independent institutions, not even sharing patient records with one another," and supervisors traditionally have "look[ed] after the interests" of the hospitals in their districts "rather than the system as a whole." And despite "repeat[ed]" attempts to reform itself, the county health care system is "wracked by crises, from medical mishaps to chronic budget woes," which placed the county on the verge of bankruptcy in 1995, necessitating a bailout from the federal government.
The Process to a Health Authority
Two months ago, following reports by the Times and a county grand jury detailing "dangerous overcrowding" in County-USC Medical Center's psychiatric emergency room, supervisors asked their staff to develop several models for creating a public authority of medical professionals to run the health department. The supervisors will hear this report on Sept. 4 and "could order an additional study." If the supervisors decide to move forward with the authority, state legislation would likely be required, as would "years of uncoupling the health system from other elements of the county bureaucracy." According to the county's administrative office, the transition could take between three and five years. The health authority itself could take such forms as a "county commission composed of experts who deal with daily medical matters and report to political leaders," or a not-for-profit organization that "contracts with" the county but "otherwise runs like a business."
National Trend?
If the supervisors decide to create a health authority, the county "will join an increasing number of public health agencies nationwide that have tried to take the politics out of health care," the Times reports. One of the more successful transformations has taken place in Denver, where the creation of Denver Health in the late 1990s has streamlined the city's health care system. The "appeal" of a health authority is having "a full-time governing board that doesn't have to worry about the jails and the police and the fire (department) and the other issues" that demand the attention of county supervisors, Larry Gage, executive director of the National Association of Public Hospitals, said. But the Times notes that several public health authorities, such as those in Chicago and St. Louis, have failed, and Gage and others warn that simply shifting control of the health department will not solve Los Angeles County's problems. "Governance changes by themselves are not panaceas. They're not going to generate another half-billion dollars in revenues overnight," Gage said (Riccardi, Los Angeles Times, 9/4). For further information on state health policy in California, visit State Health Facts Online.
