BY TONI LAPP
It's becoming commonplace: Local governments, strapped for cash, are cutting back on services.
In one California county, those "services" are two clinics operated by Alameda County Medical Center. Rising health care costs, combined with lower reimbursements for low-income and indigent patients, led the hospital system to close the clinics in June.
Such a cost-cutting move could be replicated around the country as local governments struggle to get by, said David Reynolds of the AAFP Division of Government Relations. "Most states are required to adopt balanced budgets and are now cutting their budgets, sometimes in excess of 10 percent, and it exacerbates the situation."
California, with a $38 billion deficit and no budget in place as of mid-July for the current fiscal year, is in a particularly dire situation, Reynolds noted.
In the case of Alameda County Medical Center, the hospital had run deficits for several years and, despite the clinic closings, is still $2 million in the red each month, said Rachael Kagan, a public information officer at the center. "It is a public health crisis. We can only provide the care that our financial sources allow us to provide."
Kagan said the turning point for Alameda County Medical Center came in January when it lost $7 million because of cuts in the disproportionate share hospital program -- or DSH, a federal Medicaid program that helps support hospitals that serve large numbers of indigent patients.
As a result of the closings, up to 25,000 displaced patients will have to travel elsewhere for their health care.
FP William Wallin, M.D., of Richmond, Calif., who worked in one of the clinics, said many of his patients were Asian refugees who won't seek care elsewhere.
"This is a disaster," Wallin said. "They can save money (by closing clinics) for six months, a year, but when the people start becoming so sick they end up in the ER or are hospitalized, they're going to lose money so much faster."
Many public hospitals are looking to Congress for help, said Skip Moskey, communications director of the National Association of Public Hospitals.
"Our hospitals are looking at a range of measures to deal with budget cutbacks in a time of increasing demand and diminishing resources," he said.
Kagan is succinct about what needs to be done to turn the situation around: "The only way to address it is to provide a larger subsidy (to public hospitals) or provide coverage through insurance. Decide as a society that health care is something that everyone is entitled to."
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
FP Report is published by the
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Copyright © 2003 by
American Academy of Family Physicians.