Windfall for Health Care

All signs are pointing toward this year as a crucial one for health care in Orange County. By one snapshot of the county’s health issued last month, the condition is excellent. But the really detailed look is likely to come next month, with the expected release of the most thorough examination yet of the county’s medical needs.

On the money front, 1999 could be a banner year for health care. The state settlement with tobacco companies could pump tens of millions of dollars into the county. An additional $50 million or so should flow from the new tobacco tax authorized last November by California voters. How that money is allocated is a critically important public policy decision.

The health needs assessment has grouped more than 50 public and private groups, from the county’s Health Care Agency to the 100 Black Men of Orange County, to examine a variety of issues. The study is expected to cost $400,000, with about one-third of that paying for a poll of 5,000 residents.

Topics include exercise regimens, whether children wear bicycle helmets, satisfaction with medical treatment and insurance. The resulting report should be used as a basis for deciding what problems need the most urgent attention and how money will be spent.

The genesis of the survey was a 1994 state law that required nonprofit hospitals to analyze the health needs of their communities and outline a plan to meet them. But Orange County public health officials wisely decided that a countywide approach would be more valuable than a fragmented look at just nonprofit hospitals.

All 27 hospitals in the county, nonprofit and for-profit, joined the partnership with the county Health Care Agency, the county’s health plan for the poor, known as CalOPTIMA, and dozens of other agencies to carry out the Orange County Health Needs Assessment. The report is thought to be the most comprehensive ever undertaken for such a large county or municipality: 2.7 million people.

A more limited survey, released last month by the Health Care Agency, found Orange County the second-healthiest of the state’s largest counties, ranking only behind Santa Clara. Officials said a key reason was Orange County’s affluence. There are more hospitals, more doctors and a population that is well educated and aware of risks to health and benefits of diets, exercise and the like.

The county report compared statistics on death and illness with those of other counties and with state and national benchmarks for 1994 through 1996. The county did not do as well in the rates of Asian and Latino infant mortality. Higher rates of breast cancer, tuberculosis and measles also reduced the overall good ranking. These are areas where the county must improve.

Infant mortality can be targeted with the expected $50 million the county could receive from Proposition 10, passed by the voters last November. The state began collecting the 50-cents-a-pack cigarette tax last month. The money is supposed to pay for early childhood development programs in schools, health clinics and other community settings.

Each county is to establish a small commission to decide where the money goes. So far representatives of the Health Care Agency and the Social Services Agency have been appointed to the commission, as has Supervisor Charles V. Smith. The other members should be experts in how children develop and how to deliver services.

The county needs to ensure the money is spent wisely, with as little as possible going to administration or staff expenses.

Voters were rightly worried that the increased taxes not fund bureaucracies. Spent properly, the money can improve the health and development of the very young, especially those in communities not served by existing medical programs.

Spending money on prevention is cheaper than waiting until emergencies strike. A healthy childhood increases the likelihood of good health later in life. Orange County has gotten generally good bills of health so far, but there is still room for improvement.

CalOPTIMA has helped get care for the poorest by making doctors available, but there are still problems that need to be worked out in serving the working poor who aren’t so indigent as to qualify for Medi-Cal but are too strapped to afford medical insurance. If the health needs assessment is studied and heeded, providing the basis for a strategic plan, Orange County will be well served.