CALIFORNIA: REPORT CRITICIZES LA’S PUBLIC HEALTH SYSTEM
A county-initiated review of Los Angeles County's publicThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
health program has found "a hamstrung bureaucracy, underfunded
and understaffed, suffering 'considerable tension ... with
diminished morale' and poor communication with the communities it
is set up to serve." Los Angeles Times reports that the review,
which was conducted by experts at the University of California at
Los Angeles, calls for "yet another" reorganization of the
system, including the appointment of a health officer to "expand
the mission of public health." County Health Services Director
Mark Finucane said that he was "not surprised by the findings and
will support many of the recommendations." He said, "It may
surprise people that we would air our laundry, but that really is
the only way to spur a community like Los Angeles back into the
leadership position it belongs in."
The Department of Health Services, including the public
health program, is currently undergoing a "massive
reorganization" after a fiscal crisis in 1995 that "resulted in
widespread layoffs and a $364 million federal bailout." Federal
officials have pledged $600 million over three years for a reform
of the health department. However, although that reform is
underway, the public health division is still criticized for
being in disarray. The UCLA report notes that the public health
division was hit hard during the 1995 fiscal crisis, when funding
for public health "dropped from $10.08 per capita in fiscal year
1992 to $7.68 in 1996." And in a 1995 reorganization, "the
number of sites offering public health services was cut from 45
to 10." Although the Department of Health Services is facing an
$80-million deficit, UCLA reviewers have called for a $20 million
increase in the public health program's budget of $303 million.
This recommendation is "consistent with the federal government's
expectation that the department will shift $100 million from
hospital-based care to outpatient clinics and community-based
care." Finucane said, "I agree with (the monetary
recommendation), and I will argue for it. I know I will have to
generate it out of existing resources, and I will only use it in
increments that get the recommended changes (done)."
Among the changes recommended by the UCLA researchers is
expanding the mission of public health "beyond finding and
treating disease victims and assuring safe food in restaurants"
by shifting to a community-based focus. The report states that
"there is 'a clash between what the public increasingly regards
as major community health problems and what (public health
employees) regard as their responsibility.'" The report notes
that the public health interest is "expanding to include heart
disease, cancer, diabetes, tobacco use and other issues." Other
recommendations called for: increased training of employees, the
development of modern data collection systems that enable the
efficient collection and dissemination of information, a
streamlined bureaucracy and the decentralization of the public
health system (Marquis, 9/12).
THE BEST RESEARCH RESOURCE
Los Angeles County has been attempting to implement a
comprehensive overhaul of its public health care system since
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