An advisory panel has recommended pulling the plug on the nation's largest municipal healthcare system.
In a report to New York City Mayor Rudolph Giuliani, the panel urged the "devolution" of the $3.5 billion New York City Health and Hospitals Corp. It said the current two-tiered system of care could be replaced by a single, high-quality healthcare system that assures care for all New Yorkers "in a financially feasible way."
Last week's report ignited what promises to be a raucous political battle over the future of New York City's public hospitals, clinics and services.
HHC President Bruce Siegel, M.D., expressed neither support for nor opposition to the recommendations, saying his main concern is ensuring that all New Yorkers have access to the highest quality of care.
But David R. Jones, president of the Community Service Society of New York and a member of HHC's board of directors, said that if the plan goes through, there will be "a sharp and immediate lack of access." He added that for New York City's poor and uninsured, "I think this is a gun at their heads."
Not surprisingly, the seven-member advisory panel, tapped by Giuliani and led by his health adviser, Maria K. Mitchell, builds on the mayor's effort to "privatize" some city hospitals. The panel proposed creating a special committee that would assess each facility and service currently operated by HHC and decide whether to sell, lease or transfer it.
For example, the report said one option would be to sell or lease certain public hospitals to affiliated institutions in the private sector. Many HHC hospitals have long-term relationships with not-for-profit hospitals that provide staffing for teaching programs.
The eventual goal would be to dissolve HHC.
"The panel believes that the city can more adequately ensure quality services for all persons without being a direct provider of services, but by leveraging the public dollars and seeking increased control and accountability of how those dollars are spent," the report said.
Charles Brecher, a public health professor and director of research for the Citizens Budget Committee in New York, said the asset-by-asset analysis makes sense. Brecher co-authored a report this year that recommended downsizing HHC.
But totally eliminating HHC concerns him because of the lack of a publicly sponsored organization to serve as a safety net, he said.
Patient-care advocates said the report fails to provide clear details on how such a single healthcare system would be financed and what mechanisms would be established to guarantee access to care.
"There seems to be no plan to take care of the uninsured," said Debra Goldman, an assistant director of voluntary initiatives for the City Hospital Visiting Committee, a voluntary group that oversees patient care at New York's public hospitals. "The committee feels that the voluntaries aren't going to take care of all the poor and uninsured in the city unless there's a plan to do so."
Health and Hospitals Corp.'s empire
11 acute-care hospitals
Five long-term-care hospitals
Six diagnostic and treatment centers
MetroPlus, an HMO
New York City's Emergency Medical Service
Provided 5.7 million ambulatory-care visits in 1994
Reported $3.5 billion in revenues in 1994, including
$343 million in subsidies from New York City
Posted a deficit of $147 million in 1994