UC Irvine is considering transferring the management of the UCI Medical Center in Orange to a national for-profit health care organization. Although the details are not yet well defined, the intent is to keep the faculty and the physical facilities as part of the university while all the staff will become employees of the for-profit organization. This is not the approach to take.
The impact of recent changes in health care delivery has affected the center, where the number of patients hospitalized has decreased to the point that the mission of the university hospital to carry on teaching and research is in jeopardy.
The University of California is an institution that all taxpayers of the state support. However, if the university hospital is leased to a for-profit organization, the shareholders of the private company will ultimately be the ones who will decide who can receive medical care at the center.
The main objective of a for-profit organization is to economically benefit its shareholders. Once such an entity takes over the administration of the medical center, the teaching and research programs, which are the two primary functions of the university, will most likely come into conflict with the interests of the shareholders. The company could decide that to consolidate services in only one hospital area, or eliminate programs.
In the most extreme case, if they consider that the university hospital is not a profitable operation, they may decide to close it or to sell it to another organization. Any one of these decisions would have a profound repercussion on the ability of the medical school to carry on the teaching and research.
If selling the center to a for-profit organization is not an adequate alternative, we have to evaluate other possibilities. We have to create solutions that will allow the university to continue teaching and doing research.
A basic question is what kind of health care system we would want to have in California in the next century and what kind of role we would want the university hospital to play in our society.
One conclusion could be that there is no reason for the state to support five medical schools, and that the school at UC Irvine should be closed. We are going to assume that the decision is to keep the medical school at UC Irvine open.
The next step should be to address the role of the university hospital in Southern California from the point of view of providing patient care. Patient care is the cornerstone in which the academic mission of the medical school, teaching and research, is founded. There are three critical components: the patient population, the facilities to carry the academic and patient care missions, and fiscal support.
The center is going to need to have a broad-based patient population that allows the medical students to learn the different disciplines and at the same time permits the faculty to pursue new areas of research. This implies not only patients with a wide range of diseases, but also a patient base that represents culturally, economically and socially, all the different strata of our society. This is because during their training, health care workers should not learn how to treat "diseases" but how to treat "individuals" who may have physical or mental problems. This can be best accomplished by having a health care system involving private organizations, local, state and federal agencies.
Teaching and research in the health sciences requires clinical and bench scientists to be in continuous communication. Thus, the university hospital needs to be located in a single campus that houses both basic and clinical scientists. Currently, the separation between the Irvine campus, where the basic scientists are located, and the Orange campus where the clinical scientists and the hospital are situated, makes this communication extremely inefficient.
The university should now follow through with this plan. We have plenty of sites to provide primary and secondary care but we lack a truly good tertiary hospital that can meet the needs of the next millennium.
The physical facilities of the center in Orange are outdated for the most part and will not meet our future needs.
To provide the fiscal support needed to accomplish all the goals is going to require cooperation from private and public agencies. This cooperative effort will be a logical consequence of an integrated health care system where the university hospital provides care to privately and publicly supported patients.