County Can Ease Medical Load

John Cochran is chief executive officer of La Palma Community Hospital. Carolyn Nelson, M.D., is president of the Society of Orange County Emergency Physicians

Suppose that you or a member of your family is badly injured in a major automobile accident or stricken by a serious illness while between jobs and you have no medical insurance to meet the major expenses. This is only one way in which any of us could find ourselves becoming dependent on Orange County's Indigent Medical Service for our medical care.

We as a society have a responsibility to provide for the health and welfare of the less fortunate members of our community. The overall health of our community is directly associated with its productivity and its economic viability. California places this responsibility specifically on county government, making it responsible for providing or arranging for medical care for lawful county residents who have no means to obtain the care they need. Until 1983, for the most part, the state assumed this responsibility by providing access to medical coverage to those in need through its Medi-Cal program. As a result of state budget cuts in 1982, however, the people served by the Medically Indigent Adult aid category were disenfranchised from Medi-Cal. The state, in order to achieve the necessary reduction in expenditures, provided funds to Orange County at a level the state determined would equal 70% of the amount the county expected to spend.

Unlike many counties, ours does not operate a county hospital. So in 1983, the Board of Supervisors and private hospitals and physicians established a unique public-private partnership, the Indigent Medical Service (IMS), to provide medical care to the needy. To this effort, however, our supervisors were able to commit no county funds, limiting IMS funding to the amount of the state allocation. During its first fiscal year, 1983-84, private medical care providers saw more than 3,800 patients a month, which resulted in hospital charges and physician fees of more than $45.1 million. Through IMS, the county paid $24.1 million of that.

Today, hospitals and physicians in the county care for more than 6,500 IMS-eligible patients per month. During fiscal 1986-87, those patients generated an estimated $89.1 million in hospital charges and physician fees, of which the county will pay $26.9 million.

Since the program began, Orange County hospitals and physicians have provided more than $136 million in needed medical services that were not reimbursed. And it now covers a significantly larger patient population and also the added costs associated with AIDS.

This funding shortfall, combined with a similar shortfall associated with state Medi-Cal patients, is threatening the strength of our medical-care safety net--including our hospital emergency rooms and trauma centers.

When needed medical services are forced to be cut back--or discontinued--those services are lost to everyone , regardless of financial status.

One Orange County hospital discontinued emergency services last November, and another is currently considering whether to continue its trauma center operation. In addition, increasing numbers of physicians are no longer willing to serve needy patients or to provide needed specialty coverage for hospital emergency rooms. These are the same reasons behind the deterioration of the trauma-care system in Los Angeles County.

The Orange County Board of Supervisors now has the opportunity to make a decision to assist what has become a woefully underfunded IMS program and ease the burden on our health-care system. The county has received an unrestricted state grant of $6.1 million.

(The governor vetoed a major augmentation authorized by the Legislature for the IMS program, instead choosing a block-grant approach to providing desperately needed funds to counties. This approach was chosen because funds allocated this way are not subject to the state spending cap imposed by the Gann Initiative. The governor stated in his veto message that counties will have discretion to use these funds for the highest priority programs, including medical services and trauma care. The Board of Supervisors will soon adopt an expenditure plan for these funds.)

We believe that a responsible expenditure plan will provide $4.8 million of the grant to the IMS program to support medical care for our less fortunate residents. The balance should be spent on other health- and social-service -related programs reliant on state funds, thereby rescinding the effect of the governor's veto.

By providing additional funds for IMS, the supervisors will be assisting the hospitals (and the trauma centers) and all those that deliver medical care to patients who cannot afford it and delay any reductions in emergency and urgent care for everyone.

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