Health Funding Crisis

The Los Angeles County budget for public health and mental health services for the year 1989-90 shows a slight overall increase over the previous year, but that increase conceals deteriorating services because, once again, the funds are keeping pace with neither costs nor case loads. This is the situation also in Orange County, in San Diego County, in virtually every county of the state. But nowhere is it as critical as in Los Angeles County, because of its concentration of poor people, homeless people and the acutely mentally ill.

There is a prospect of some relief when the state Legislature and Gov. George Deukmejian complete negotiations at the end of the summer on the distribution of new tobacco tax revenues and on supplements to the previously agreed-upon state appropriations. But those additional funds will not reverse the deterioration. And there is a risk that the tobacco tax money, earmarked by the voters in Proposition 99 last year for new programs, will be lost in rescuing old programs.

The Department of Health Services has come out of the county budget negotiations with a total of $1.6 billion, compared to $1.57 billion last year. In terms of cash, it is effectively a standstill. In terms of services, it represents a cutback because of cost increases. The dimension of the shortfall is best understood when the actual budget is compared with the $2 billion budget proposed last year. In other words, there are clear needs for at least $400 million more.

Deterioration is evident at almost every level of health service. The waiting time last week for access to outpatient clinics at the County-USC Medical Center averaged more than five weeks at 39 of the clinics, and up to six months at three others. Virtually every use of the county system, including deliveries of babies, emergency room cases, outpatient clinic visits and hospital admissions, hit record levels in the fiscal year just ended. And matters will get worse unless new state funds are found because some of the outpatient clinics are funded only through September. There is no funding in the current budget to cover uncompensated care and emergency room services at private hospitals, increasing the likelihood of further breakdown of the trauma network.

The Department of Mental Health is also in crisis, requiring $8.6 million in additional funds just to stand still. And standing still means doing nothing to address the severe problems pointed out last month in a study by Coopers & Lybrand for the county grand jury. That report underscored a gross inequity in state funding, because the state does not use a formula that addresses the severity of the mental health case load. The county last year, for example, received 34.6% of the state mental health funding, even though it has 42.1% of the most severely ill mental aid patient admissions in the state. The county estimates critical unmet needs in mental health at $139 million.

These grave problems affect every person in the state, not just the poor. The long-term solutions will come from a better organization of the health care system. But in the short term, the compromise on funding education, transportation, health and welfare agreed on in Sacramento, and being submitted next year to the voters, offers an appropriate response.