Health Care for Poor Is Expected to Keep Slipping : Medicine: Higher-than- average percentage of uninsured patients is putting increasing financial burden on San Diego hospitals, a study finds.

Without immediate structural changes, San Diego’s health-care system will increasingly fail to meet the needs of the county’s growing body of poor and indigent residents, according to a “report card” issued by the Hospital Council of San Diego and Imperial counties.

“We have earned a ‘D’ grade and are well on the way to failing to meet the access to medical care needs of San Diegans,” according to a statement released Friday by Jim Lott, the council’s president and chief executive.

The council authorized the indigent-care study earlier this year because its members grew “increasingly alarmed” after 1988 losses linked to charity cases and bad debt rose to $46 million.

Although past health-care studies have evaluated the county’s indigent-care problems, “from a fragmented perspective, we felt it was really essential to sit down and take a look at the whole system’s problems,” said Jan Gould, a UC San Diego Medical Center administrator who served as a member of the council’s Indigent Care Task Force.

The report suggests that hospitals could “find themselves in conflict with the communities they serve” as they struggle to balance a “growing burden of uncompensated care” with the need to remain financially viable.

The council’s report card presents a bleak picture:

* More than 25% of San Diego’s non-elderly, non-military population has no health insurance. Statewide, the uninsured percentage is closer to 20%, and nationwide, 17.6% of the population lacks health insurance.

Among the nation’s top 20 major metropolitan areas, San Diego has the second-highest percentage of non-elderly population with no health insurance of any kind. Those San Diegans face an uncertain future because “people without health insurance have substantially less access to necessary medical care than those with health insurance,” according to the report.

In addition to the uninsured population, 25% of San Diegans now rely upon government health-care programs that fail to reimburse hospitals fully for the cost of providing services.

San Diego has not “experienced the devastating disruptions of major hospital closures and service reductions,” but the combination of uninsured and under-insured patients could bring “several key hospitals to the brink of closing or (force) major service reductions,” according to the report.

The report notes that only two local hospitals have closed in recent years, but that more closings will occur because “circumstances could quickly change.”

* The county’s six emergency and trauma service departments are “struggling” to handle a growing wave of uninsured and under-insured patients, according to the report. The county “boasts one of the finest trauma systems in the country . . . (but) one needs only to look north to Los Angeles to see what San Diego can look forward to if fundamental changes in the financing of health care are not made.”

Los Angeles’ financially troubled system has forced some hospitals to close their trauma operations, while others have downgraded the level of services available. San Diego’s six trauma centers generated a $9.2-million net loss on $66.6 million in revenue during 1988, according to the report.

* Federal and state programs are largely to blame for the “eroding indigent-care” system, but San Diego County “stands out as one of the least responsive (counties in California) to local health-care needs and problems,” according to the report.

San Diego “ranks 57th of 58 in per capita total revenue appropriated for health-care mandates by the state,” according to the report. “Only Butte County, with a population of 164,000, has allocated less revenue per capita to fund state-mandated health programs.”

Although the report focuses heavily upon problems, it offers an “action plan” that includes a call for local hospital administrators to spend more time lobbying health-care regulators and legislators in Sacramento and Washington.

The council report also urges administrators to support efforts to enact a minimum health-insurance package sponsored by a “government-private sector partnership.”