Health Crisis Report: Lots of Open Questions : OK for now, but it doesn’t do much for systemic change

Los Angeles County’s Health Crisis Task Force has delivered a plan to save county hospitals, but at the expense of closing 30 walk-in health centers and clinics. Cuts are inevitable; the only question is which cuts are most palatable given the population and size of the sprawling county. The task force raised the prospect of fundamental reform in the county’s health care delivery system but so far has fallen short of laying a foundation to restructure public health services.

Is the plan a mere stop-gap that props up an outdated, hospital-centered health care system? Will the private sector fill in for discontinued county health services? Orange County, for example, contracts out its health services, and the results are at best mixed. These are the questions that the Board of Supervisors should raise when it considers the plan today.

REVERSIBLE MOVES: The task force unveiled its plan on Monday. The premise is that all cuts should be reversible--so if, miraculously, more federal funds are available, trimmed services can be easily restored. The task force assumes, rightly, that if millions of federal or state dollars were made available later this year, it would be easier to reopen the clinics and health centers than to reopen a major hospital.

Thus the proposal spares hospitals, especially County-USC Medical Center, from closure. Rancho Los Amigos Medical Center, a nationally acclaimed rehabilitative hospital, would be sold to private interests and the number of county health administrators would be cut by half. In addition, all in-patient services at High Desert Hospital in Lancaster would be discontinued, leaving the facility open for walk-in treatment only. The new plan, however, is less Draconian than Chief Administrative Officer Sally Reed’s proposal to close County-USC, four comprehensive health centers and 19 neighborhood clinics.

The trouble with the plan is that it maintains an expensive, antiquated hospital in-patient care system. In contrast, the health care industry standard followed by most insurers and health maintenance organizations is a less costly outpatient clinic system. The task force decided to maintain County-USC because it said that closing 30 clinics and health centers would have a less drastic impact on the public health than closing the hospital, which handles one-fourth of the county’s millions of 911 calls each year. It opted to keep the other hospitals open even though all but one do not meet earthquake safety standards. The rationale was if they were closed they might never reopen because of the costly repairs needed.

Initial estimates are that 1.4 million patient visits would be lost under the proposal. Those patients may end up in the emergency rooms at the county hospitals. The county could contract with private hospitals to fill some of the void, although it is not possible for them to accommodate all of those needy and sick. But for other non-emergencies, on any given day more than half of the rooms in private hospitals are vacant. For example, might the California Medical Center operate one or more comprehensive health centers in South-Central Los Angeles on a contract basis? That would be a step toward restructuring county health services.

HEALTH CZAR: The task force also recommends the appointment of a health services czar to shepherd the county through this difficult time. That would make sense only if the county undertakes major change in the health system rather than simply revert to the old one.

The deficit in health services accounts for more than half the county’s entire $1.2-billion budget shortfall. The task force, which was not expected to solve all this in a mere four weeks, has helped avoid a total county health meltdown. But the long-term problems loom large.