ORANGE COUNTY 1990 : Experts Predict Radical Changes in Medical Care

The brave new world of medicine in the 1990s may bring more lasers than scalpels, more outpatient procedures than costly hospital stays and probably some form of government-mandated health insurance.

The latter idea may sound radical but many health experts--from Orange County Medical Assn. director John Rett to insurance executive Joe San Filippo to SOS Free Clinic health advocate Vicki Mayster--believe that by the mid-’90s, some form of universal health coverage will arrive.

They differ on what form it will take. But Rett, San Filippo and others suggest it will come soon, with doctors and large corporations seeking state legislation requiring firms with five or more employees to provide insurance.

Mayster offers a grim vision of the early ‘90s in which the health system collapses for all but the rich. Nearly 400,000 county residents have no health insurance now and their ranks will swell as the decade begins, she said. And once the county trauma system collapses and insurers limit their coverage, middle-class frustrations will rise. The result? Mayster believes poor and middle-class residents will join “a broad-based, grass-roots movement” for national health insurance.

More optimistic was UC Irvine Vice Chancellor and Medical School Dean Walter Henry. By the early ‘90s, he suggested, county supervisors will solve the problems of indigent care--and will keep the trauma system alive. “I see movement toward solutions,” said Henry, who noted that both Supervisor Harriett M. Wieder and state Sen. Marian Bergeson (R-Newport Beach) have task forces on health care.

Henry was also bullish on the future of his 21-year-old medical school. With plans to build new institutes, open a futuristic science library in 1991 and recruit distinguished professors, UCI’s medical school will rival UCLA’s by the late 1990s, he said.

Also changing fast is UCI Medical Center in Orange. With a new cancer center, psychiatric hospital and medical office building going up, the former county hospital in Orange will shed its image as a facility for the poor, said deputy executive director Herb Spiwak. And by 1995, the currently debt-ridden facility should turn a profit as it specializes in “esoteric high-tech” treatments--heart, liver, kidney and maybe even pancreas transplants, Spiwak said.

But at UCI Medical Center and other hospitals, the new technologies won’t come cheap. Lab and doctors’ fees are expected to rise, although experts decline to say by how much. As for the price of a hospital room, “you don’t want to hear the number,” said William Noce, chairman of the Hospital Council of Southern California. Another council official said room rates, now about $813 a day, should continue to rise through the ‘90s by at least 4.9% a year.

For all the price hikes, nurses are afraid their salaries, now up to $43,000 a year in Orange County, won’t keep pace. But if they don’t, and if nurses aren’t allowed to participate in hospital decision-making, “there’s a possibility of no nurses” in the ‘90s, warned Sara Sanford, executive director of the Assn. of Critical Care Nurses in Newport Beach. They would pursue other careers, she said, and their jobs would be done by technicians.

Rising costs and medical advances have led to what UCI management professor Paul Feldstein calls “the hospital without walls.” More drug therapies, complex diagnostic tests and surgery will be available for outpatients, he said.

Another trend parallels the rise in Orange County’s elderly population. To serve these patients, doctors and other experts promised more specialists in cardiology, Alzheimer’s disease and geriatrics. Also, a politically active population of seniors will assure that Orange County nursing homes are run better, some possibly following the homelike model of Scandinavian nursing homes, said Chauncey Alexander, chairman of United Way’s health care task force.

Experts also predict a new emphasis on preventive care in the ‘90s. “People will become more responsible for their own health care,” said Tom Uram, director of Orange County’s Health Care Agency. “You’ll eat better. You’ll exercise better. We’ll become smart. We’ll finally find out what cholesterol is about.”