County-USC Price Tag Is a Bargain

The Los Angeles County Board of Supervisors is poised to decide the future of the County-USC Medical Center in East Los Angeles--whether to rebuild this worn out, earthquake-ravaged facility and, if so, at what size.

The largest hospital on the West Coast faces ever-increasing costs. It admits 56,000 poor and indigent people a year for life-threatening acute and chronic medical conditions. Currently it’s budgeted and staffed at 860 beds.

Replacement options range from a unit of 391 beds to one of 946 beds. We think that a 750-bed center would serve the county best, with private-sector hospitals and physicians taking up the overflow.

An average of 830 inpatient beds are occupied daily at County-USC, so a 750-bed hospital would not meet current or future demand, given expected increases in the county’s population. Nonetheless, providing fewer county-managed beds than calculations would justify is a prudent and responsible approach, especially if supplemented by public-private partnerships to manage the difference.

Most of the private-sector physicians and hospitals we represent firmly believe that the supervisors should reject anything less than a 750-bed replacement hospital. A smaller unit would put unreasonable strains on the indigent care safety net.

The cost to operate and maintain a rebuilt 750-bed County-USC Medical Center would be just $26 a year for each county resident. That’s a bargain-priced premium for ensuring access to life-saving medical care for the poor among us and for preserving the integrity of the emergency medical services for all county residents.

County officials throughout California have had to make similar decisions. Faced with relentless cuts in federal and state funding, increased demands by growing numbers of medically uninsured residents and the diversion of funds from social programs to law enforcement and the criminal justice system, 32 counties have either closed or sold their hospitals in the last three decades. Three counties contracted with the University of California to run their hospitals; the others rely on private-sector hospitals, physicians and community clinics to meet the needs of the poor and uninsured.

But Los Angeles County is not just another county, and County-USC is not just another hospital. The fact that federal and state funds are available to rebuild the facility acknowledges the importance of County-USC to the public health of the region as well as to the entire county trauma and emergency medical care system.

Los Angeles County’s population is larger than that of 43 states. Unfortunately, of the county’s population under age 65, nearly a third are medically uninsured. Absent legislation to provide coverage to more of the medically uninsured, their ranks in Los Angeles are projected to grow by at least 25,000 persons a year well into the next century.

How will we meet this need? While the current number of public and private hospital beds in Los Angeles County now exceeds population needs, studies project a 23% reduction in private-sector capacity over the next 10 years. The same studies identify a current and future shortage of emergency medical service capacity throughout most of the county, which would significantly worsen without County-USC.

By 2005, county and private-sector trauma and emergency hospitals will face a demand for 353,000 more emergency medical interventions a year than the system will have the capacity to serve in a timely and safe manner. Without County-USC, add another 250,000 encounters annually to this scenario. The lives of everyone in Los Angeles County needing emergency medical care would be threatened as hospital emergency rooms become dangerously overloaded and ambulances scrimmage to find facilities open to new patients.

An extremely fragile balance exists between services provided by county hospitals and the ability of the private sector to care for the uninsured. The prospect of rebuilding County-USC Medical Center at fewer than 750 beds would be taking a risk we cannot afford.