What on earth are health policy leaders in Los Angeles County thinking?
A health crisis task force there has come up with a plan that would avoid the shutdown of giant LAC-University of Southern California Medical Center and other county hospitals. And what's included in their proposal? A plan to shut down all but 10 of the county's 45 outpatient health centers-including outpatient clinics at county hospitals.
Public healthcare systems serving the poor should be focusing on more, not less, outpatient care. However, both health executives and public officials seem to be primarily driven by the desire to protect bloated and inefficient healthcare institutions that create and preserve jobs and provide revenues to the local economy.
The Los Angeles County plan is reminiscent of a proposal by officials in Chicago to build a $570 million replacement facility for Cook County Hospital. Officials in both cities ought to capitalize on existing capacity in their overbedded markets and jump with a vengeance into increased outpatient care. Instead, they are perpetuating public healthcare systems that are dinosaurs in an age of managed care.
Granted, something has to give as Los Angeles County officials seek to close a $1.2 billion budget deficit. But county supervisors didn't help the situation when they adopted the task force's ill-advised plan last week with modifications that preserve additional inpatient care.
Los Angeles officials know that reimbursement comes chiefly from inpatient services and losses are in the outpatient-care arena. They think the feds should cough up $300 million for a Medicaid demonstration waiver that will allow them to put new funds into rebuilding outpatient services. But they don't need to wait for a grant to refocus their healthcare delivery system on wellness and prevention efforts that keep people out of the hospital-or at the very least treat patients in the most cost-efficient setting. Shutting down outpatient facilities will reduce preventive services for many poor and uninsured residents, who will be forced to wait until they are really sick and then seek emergency-room or inpatient treatment.
Leaders in California healthcare have missed an opportunity to develop a better idea to reduce waste and inefficiency in the public health system.