UCLA Policy on Medi-Cal Patients

The decision by the UCLA Medical Center to reduce the number of Medi-Cal patients it will serve in the future is another sad chapter in the story of the development of a two-class medical care system in the United States. Although Medi-Cal, at its inception, was designed to allow the medically needy to enter the “mainstream” of the American health-care system, it has in fact led to the creation of a medical “underclass.” Its beneficiaries are, in most cases, relegated to overcrowded hospitals, burdened with caring for the poorest and sickest of the community with too little space and too few resources.

The number of “private” health-care providers who will accept Medi-Cal patients grows smaller each year, as providers feel unable to accept the low rates of reimbursement and are overwhelmed with bureaucratic barriers to payment. The morality of this point can be debated, but it cannot be said that UCLA has neglected its obligation to serve the medically needy. As was pointed out in your article, UCLA has subsidized the care of poor patients to the tune of $200 million over the last decade.

Rather than an indictment of UCLA’s decision, I regard the lack of hospital beds for poor patients on the Westside of Los Angeles as an appalling lack of commitment on the part of our community hospitals to participate in their care.

Your article graphically illustrated the differences in the number of patient days paid for by Medi-Cal among the various Westside hospitals. None of them even comes close to UCLA. While the inadequate reimbursement and bureaucratic barriers involved with Medi-Cal are well-known, it’s time for the burden to be shared by all the hospitals in the community. The county hospitals simply cannot absorb any more patients.

UCLA has been forced to reduce the number of Medi-Cal patients it accepts because of serious financial considerations, but it still maintains a commitment which far exceeds that of any other non-county facility in the area. What defense do our community hospitals offer for shouldering virtually none of the Medi-Cal burden? We should all be more active in lobbying for better Medi-Cal reimbursement and less administrative red tape.

DEIDRE SPELLISCY GIFFORD MD

Los Angeles