ORANGE COUNTY VOICES : It Helps All to Keep Medical Center Open

The much-discussed financial crisis at University of California, Irvine Medical Center, did not develop only recently. The regents of the University of California have been hearing of the dire financial picture at UCIMC for many years. It was not until the regents began talking openly and very seriously about closing the hospital that the issues have received increased public attention.

Over the years, Orange County’s indigent and Medi-Cal patient load has grown substantially. In turn, there has been a reduction in Medi-Cal participating hospitals.

Despite the reality that UCIMC is not a county hospital, it remains identified as such. Consequently, no university-owned hospital in the nation has a higher percentage of indigent patients than UCIMC. With only 6% of the hospital bed space in the county, the Medical Center last year treated 50% of the county’s Medi-Cal patient load--and lost $29.3 million due to insufficient reimbursement from Medi-Cal.

The county, not the University of California, has the legal responsibility for health care for indigents under state law. However, Orange County government has refused to accept its responsibilities for indigent health care, finding it more convenient to pass this burden onto the health-care providers and UCIMC in particular.

It is enlightening to see how other counties have addressed this same problem. In 1989-90, the Orange County Grand Jury compared five similar counties and discovered that Orange County was the lowest provider, by far, of overmatching state funds, as a percent of total county costs. The result: a real gap between services needed and services funded for county indigent patients.

What would be the results if this situation is not resolved?

The university is looking at a range of options. Its most dramatic response--but the least desirable--is to close the doors at UCIMC. Closing the hospital would have far-reaching negative consequences on the delivery of health care in Orange County.

Indigent patients would find it much more difficult to obtain necessary medical care and would wait until their illness has progressed much further before seeking it. With so few other hospitals now participating in the medically indigent and MediCal contract programs, UCIMC’s departure from the health-care scene would signal to these other hospitals a real lack of commitment by the county to cover its financial obligation to impoverished patients.

An important fact is that excellent medicine is being practiced at UCIMC. Closing it would have a decided negative effect on the quality of health care attainable to all of us. For example, UCIMC has the only burn unit and poison-control center in the area. Its department of neonatology is known nationally, and has helped countless newborn infants survive and live healthier lives. UCIMC is also a major provider of obstetrics care.

Because of this crisis, the University of California has requested two very important actions from the Board of Supervisors.

1) We have asked that $3 million be restored to UCIMC through the Hospital Council in this year’s fiscal budget for our service to indigent patients and that an additional $5.1 million be restored to other Orange County hospitals who participate in the Hospital Council and who also serve indigent patients.

2) We want the participation and commitment of the county government in working with the university, the Hospital Council and the Orange County Medical Assn. to devise and put in place a primary care-referral system.

The requested cash payments, although vital to our current operating needs, are only a Band-Aid on the enormous wound of indigent health care in Orange County.

What is even more of concern to the university is to establish a primary care referral system that would require all Orange County hospitals to share in the delivery of quality health care to Medi-Cal and indigent patients. This system of shared responsibility is the correct and fair long-range solution to the problem.