THE COSTS OF THE COUNTY’S COST-CUTTING : Health Care Alliances Are Needed : A partnership of doctors, medical providers should do its part for area indigents.

As the debate rages over how to pull Orange County out of bankruptcy, a small yet significant group endures in silence. They are the children, the elderly and the poor who depend on the county for health and social services. Proposed budget cuts will have profound ramifications on the needy and the entire county.

More than 1,000 county employees could lose their jobs, most of whom work in health care and social services. The proposed cuts would result in less money to administer emergency medical services, immunizations, alcohol- and drug-abuse treatment, mental health services, AIDS testing and prenatal care. Cuts in social services mean sacrificing hard-fought gains in the war against child abuse, drug abuse and other social problems.

Must worthy programs be at risk? I believe that the private sector--hospitals, HMOs, community clinics and independent physicians--can work together on a solution until the county’s fiscal situation is healthy again.

One program for the poor that is jeopardized by the bankruptcy is Medical Services for Indigents, which now covers approximately 18,000 people who cannot qualify for Medi-Cal or any other form of care. The county must provide matching funds to obtain state grants to operate the program, which partially reimburses hospitals and other health-care providers. If the county can’t come up with the matching funds, it could default on the MSI program.

Anyone seeking emergency room treatment could feel the impact of such a default. Here’s why: Most MSI patients don’t see doctors regularly, but rely on hospital emergency rooms for care. If the program defaults, the funds could dry up completely. Hospitals already in a belt-tightening mode may have no choice but to make staffing cuts. The result? Longer waits in the emergency room for all patients.

The county’s concern over the bankruptcy’s impact on MSI and other health-care programs has prompted a new bill to temporarily waive state mandates on health-care programs. Its goal is to allow the county more flexibility to set priorities for programs it wants to fund. But the proposed waiver has come under fire from the Orange County Medical Assn. and many providers who fear the impact on public health and the increased burden of caring for more patients at reduced compensation.

If the county approves the proposed budget cuts, it’s clear that the community’s physicians and health-care providers must assume some responsibility for caring for the county’s needy. The question is how to shift care without bankrupting the health-care providers. One way is to forge health-care partnerships to share the burden.

In recent months, local HMOs, hospitals, clinics and physicians have linked up in an unprecedented fashion to win contracts from OPTIMA, a new state-funded managed care system that is gearing up to provide health services to the county’s estimated 300,000 MediCal recipients. Why not learn from the providers’ experience with OPTIMA and examine how these health-care partnerships can serve more of the county’s needy?

Ideally, this would mean greater support of the county’s 15 community clinics. The clinics can provide preventive care, offer some of the programs that may be eliminated at the county level and prevent emergency room crowding.

To do this, clinics will need stronger community support in the form of grants and donations, collaborative fund-raising efforts, and more skilled volunteers. The Coalition of Orange County Community Clinics is developing a plan to address the bankruptcy’s impacts. Community clinics need our financial support and encouragement so they can help those who cannot help themselves.