Health Agency Study Ordered

A proposal to get Los Angeles County out of the health care management business inched forward Tuesday when county supervisors voted to form a commission to study the idea.

The concept of ceding control of the $2.4-billion-a-year Department of Health Services to a separate public authority has been on the table for six years and was first suggested by a citizens commission.

Though Tuesday’s action took the idea further, the supervisors were clearly concerned about a wide array of unresolved issues. Still unclear is who would run such an agency, what its responsibilities would be for the uninsured and whether it would make a difference in a public health system struggling with a massive deficit that could cause hospital closures.

Supervisor Yvonne Brathwaite Burke noted that private hospitals, which do not share the county’s responsibility to treat the uninsured, are also fighting to stay solvent.

“They have the same problems we have,” she said. “There are not a lot of examples that give us cause for a lot of optimism.”

The board hopes that its new 17-member commission, consisting of medical experts, county administrators and a representative of labor unions, will provide answers.

The commission will study the issue, hold a public hearing, then report to supervisors in December. Options for overseeing health care include a semi-public nonprofit corporation, an authority with a board of medical experts, a similarly constituted panel that reports to supervisors or a new hospital district with the power to assess property to raise money for medical services.

“I don’t think we should be afraid to air all the issues,” said Supervisor Zev Yaroslavsky, who, with Supervisor Don Knabe, proposed the study. “We can’t focus 100% of our attention on one department. . . . We are more surprised week in and week out about what happens in [the health] department than we are in control of what happens.”

Local medical experts have long called for the board to surrender control of the department, saying supervisors pay more heed to medical issues in their own districts than countywide. With an $884-million deficit four years away, the experts said such a change is critical to get more state or federal aid.

“The county’s experience over the past few years, it must be admitted, has created some doubts in Washington and Sacramento,” said Dr. Lester Breslow, a former director of the state health department, alluding to the county’s failure to reform its medical agency.

But Supervisor Mike Antonovich said the benefits of a health authority--swifter purchase of medical supplies and hirings and firings--could be achieved by internal reforms rather than creation of a new agency. He asked county staff to report on ways supervisors could streamline the department now.

Kathy Ochoa of Service Employees Union International Local 660, which represents most of the county’s 23,000 health workers, was also cool to the authority idea. “This is not about getting yet another report on health care governance. What will help . . . is getting more money into our already beleaguered health care system.”