A Government Obligation

Orange County hospitals are competing hard for paying patients. Some advertise. Others have cut their emergency room rates to attract “customer-patients,” those with cash, credit cards or insurance.

But when it comes to treating the poor--those who must rely on government programs to pay for their health care, the uninsured and illegal immigrants who have have no protection at all--the competition ends. Most hospitals are content to let the UCI Medical Center handle those high-cost, low-income government-financed cases. Some even direct their patients to the UCI Medical Center, a practice known around the country as “dumping.”

And so 70% of UC Irvine’s hospital bills are paid with federal, state and county funds, which usually fall far short of the costs involved in treating patients. And although 31 hospitals in the county have contracts to treat the so-called “working poor,”people who are not on welfare but still cannot afford to pay doctors, 40% of those working poor are cared for at the UCI Medical Center or one of its clinics.

The result, as was documented in a recent three-part series by Times reporters Marcida Dodson and Bill Billiter, is a quality medical facility in dire financial straits facing a deficit of nearly $10 million in the current fiscal year that ends June 30.

With expenses running higher than reimbursements, the solution to the medical center’s financial problem is obvious. It must get more paying patients. And more money from the federal, state and county governments that have the obligation of paying for health care for the needy.

That’s the direction UCI officials have been trying to go. But it’s no easy task. The medical center, as modern and efficient as it is with the latest in research and equipment, still is fighting an image problem in trying to attract paying patients to a medical facility that some people mistakenly still consider the county poor house. And governmental funds on every level have been harder to obtain in recent budget years.

Still, it could be easier to reduce costs if more doctors, who gladly associate themselves with the university hospital and medical school to gain prestige, would also practice there and admit their patients to the medical center. It could also be easier if government would recognize not only its responsibility to care for the poor but to provide the facilities charged with the task adequate funds to do the job.

In competition with other hospitals and in its effort to provide care without losing large sums of money in the process, a university hospital such as the UCI Medical Center has built-in disadvantages that are difficult to overcome. Treating the poor is one of the most expensive operations. It is both a teaching and a treating hospital, which involves even higher operating costs. And UCI has a contract with Orange County to carry out its responsibility to treat the indigent.

The contract was entered into by UCI and the medical school to secure a teaching hospital when the Legislature decided that instead of building new hospitals that would primarily serve more affluent patients, it would acquire existing ones.

But the state also cut back funding, and there has been some criticism that the county has not always covered all the costs it should. A new county contract, however, is now being completed, and it’s in the county interest to make it as equitable as possible. Otherwise the university could lose so much money that it would be forced to cancel and throw the entire burden of treating the poor back on the county.

We support UCI Medical Center’s efforts to attract more private patients to offset its costs. But as wise as it is to seek large numbers of paying patients to spread the costs, care must be taken not to overlook the hospital’s mission of serving the poor.

To ensure that, more government funds must be made available. There are proposed bills, such as the $26.6-million bail-out bill for university hospitals now pending in the Legislature. And the governor has proposed increased funding, albeit inadequate, for the working poor and the reorganization of Medi-Cal. That indicates Sacramento may be ready to provide more of the help it should have been giving campus hospitals all along.

Government historically funds services such as fire, police and education. Health care for the poor is no different. There is a strong public health interest as well as a moral obligation for government to ensure that everyone in the community can secure the medical attention he or she needs. At the UCI Medical Center, which is the treatment center of last resort for the poor, medicine still carries a higher priority than money. That’s how it should be everywhere.