LOS ANGELES COUNTY: Looking To Washington For More Funding
Despite Los Angeles County's much-cherished federal Medicaid waiver, the public health care system "still struggles to keep its head above water," American Medical News reports. Since the federal waiver kicked in, some progress has been made, as it has enabled health officials to shift "the health system from costly inpatient care to community-based primary and preventive care." Not only are inpatient hospitalizations on the decline, but emergency room visits have fallen by 27% and ambulatory care visits have increased by 600,000, "all signs of improvements in health care utilization." Many problems remain, however. Of the state's ten million residents, more than 20% lack health insurance. Efforts to reduce inpatient care actually result in counties losing Medicaid reimbursement money. "A decline in inpatient care yields very little net savings to the county due to losses in federal and state revenues," states a report requesting the waiver extension. Furthermore, the county will soon be asking for an extension of that waiver, seeking almost twice the current amount.
The Private-Public Conundrum
The county's private-public partnership has been both a blessing and a curse. Since 1995, the county has encouraged cooperation between the two sectors, recommending that some private facilities become primary care providers, leaving public clinics to take care of more basic public health needs. That arrangement has made services more accessible to patients, but has also led to some confusion for those seeking access to specialty care. Patients in clinics tell tales of struggles to "get tests, specialty care or surgery despite having received the appropriate referral." "Overall, patients are very confused," said Beth Osthimer, of San Fernando Valley Neighborhood Legal Services, adding, "They don't know how to access the system, and there is little in the way of outreach or education about services." The county is convinced it needs continued federal funding to smooth out these difficulties and work on providing care to its indigent population. Michael Cousineau of USC's Center for Policy, Planning and Development, says with increased funds, the county would focus "on core public health services and better disease surveillance." He said, "That's something that the county can't let go of. Nobody else will do that" (Shelton, 8/2 issue).