Sharper Health-Care Focus

Setting up an independent agency to govern Los Angeles County’s troubled health care system is not going to solve its immediate fiscal crisis. That’s what the skeptics on the Los Angeles County Board of Supervisors said last week, and they’re right. But they were also right to take a second, unprecedented step toward setting up such an agency, especially after a preliminary study said it could well improve health services overall.

The county serves as the safety net for low-income residents, including nearly 3 million who lack any form of health insurance. The root of its fiscal crisis is simple mathematics: As this population grows, there has been no corresponding increase in funding due to the restrictions of Proposition 13 and the legislative actions that transferred money from counties to the state.

The county was on the brink of bankruptcy in 1995 when the Clinton administration bailed it out. The five-year federal aid package was extended in 2000, but by 2005 the county health department will face a projected deficit of $884 million. It will fall short $250 million as early as next year if the Bush administration goes through with ill-advised cuts to public hospitals.

The supervisors rightly recognize that the responsibility for keeping hospitals, emergency rooms and clinics open rests with them, even if the bucks appear to stop far short. For this reason and a few others--like being able to deliver clinics or other perks to their districts--they have been reluctant to let go of the day-to-day oversight that they now hold over the system.

But the crisis has prompted some new thinking on how best to manage an increasingly complex system with ever-scarcer funds. So at the request of Supervisors Don Knabe and Zev Yaroslavsky, county staffers examined four types of governing boards, ranging from a semi-independent commission that manages day-to-day operations but still reports to elected officials to a private nonprofit corporation that takes over operation and ownership of hospitals and clinics.

The study looked at places around the country where each had been tried. Benefits cited included greater flexibility in contracting for services, managing resources and recruiting doctors and nurses. Significantly, patient care also improved.

Turning the hospitals over to a private corporation is both too complex and too extreme. But the benefits of establishing a commission or a more independent authority, besides those cited above, are time, focus and expertise.

Rather than leaving the increasingly complex problems of health care to a Board of Supervisors that oversees more than 30 other departments, the county should establish a board of trustees whose single purpose is to make the health department work.