CALIFORNIA: REPORT CRITICIZES LA’S PUBLIC HEALTH SYSTEM

      A county-initiated review of Los Angeles County's public
 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."  
      HISTORY
      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)."  
      UCLA RECOMMENDATIONS
      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
 1995.  Use American Health Line's fast and easy search service to
 find past stories on the county's efforts.  For example, enter
 "Los" and "Angeles, or enter other key words to search other
 health care topics.