Los Angeles County's search for private partners to take over 22 outpatient primary-care clinics has stalled. Most responses to the cash-strapped county's latest request for proposals were deemed unacceptable.
That's not surprising because the county has no funds to pay potential partners. Mark Finucane, the county's new director of health services, "believes he will get better-quality responses when there is funding available," said James Lott, executive director of the Healthcare Association of Southern California, a hospital group.
Finucane is seeking county funds and philanthropic matching donations to keep the clinics alive, Lott said.
Meanwhile, both the Los Angeles County Medical Association and the hospital association have sounded an alarm over cuts in county public health services.
Facing a $750 million budget deficit last year, the county decided to close 28 outpatient clinics, which housed both primary-care and public health services targeting communicable diseases such as tuberculosis.
A $364 million federal bailout and Medicaid waiver has allowed the clinics to remain open, with reduced staffing, while the county seeks to privatize them. Private companies have taken over six of the clinics, but their public health services have not been restored, Lott said.
Of about 40 public health clinics, which were housed in the same facilities as the personal health clinics, the county has closed all but 11, and immunization rates have dropped sharply, according to Brian Johnson, M.D., president-elect of the county medical association and an emergency medicine physician at White Memorial Medical Center in Los Angeles.
A study by the county's Department of Health Services and Michael R. Cousineau, adjunct assistant professor at the University of California at Los Angeles School of Public Health, shows that tuberculosis clinic visits decreased by 68% from January 1995 to January 1996. Visits for treatment of sexually transmitted diseases dropped by 55.8% and immunization visits by 58.2% in the same period, the study showed.
The county had been immunizing an estimated 25% of infants and toddlers in the general population; that percentage has dropped to about half that figure, a county health department spokeswoman said.
Since the county provides free vaccines, she said "it's very likely" the rest are being immunized by private providers and at primary-care clinics.
But Johnson said he is concerned that public health services are not being addressed in the current move toward privatization.
Lott said public health and communicable disease control ought to be reclassified as public safety programs, like fire and police protection, to obtain adequate funding.
The county should move quickly to restore public health functions even if it means reducing primary-care services, leaving those to private operators, Lott said. The county "ought to do what they do best," he added.