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Out With the Old, In With OPTIMA : * New Approach to Health Care for the Poor May Not Be Perfect, but It’s Not Medi-Cal

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There may indeed be problems with the model being used by Orange County to reform its health care delivery system for the poor, but it certainly will be better than what the county has now.

Orange County has wisely planned the overhaul of its hobbled system, and is scheduled to replace it in January, 1995, with the OPTIMA program, which is modeled on the Santa Barbara Health Initiative. The County Health Care Agency properly recognized that the state-funded Medi-Cal system was serving its 250,000 indigent recipients poorly with its cumbersome and inefficient plan.

The problems with the old plan were easy enough to see. Medi-Cal has emphasized crisis care, deferring basic health maintenance and leaving patients to have their primary care handled in hospital emergency rooms, which are in a crisis and are expensive.

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The Santa Barbara system has showed that its patients used hospital emergency rooms only 43% as often as their counterparts in the state-administered Medi-Cal program and were hospitalized only 62% as much. And having a locally managed system has saved the state a total of $12.8 million in Medi-Cal funding from 1983 through 1990.

Moreover, the system provides continuity of care with case managers, using specialists only when necessary. And local control has allowed for flexibility in prescribing funding payments for drugs and treatments not allowed by the state according to individual needs. Orange County is now in line to realize similar benefits.

All is not paradise in the model, which funds fewer specialists, leading to long waits for appointments and a need to use county clinics to deliver services. But Santa Barbara seems to be trying to address some of those shortcomings with creative management.

The system may not be perfect, but it’s better than what Orange County has, and can be fine-tuned.

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