Sharing Indigent Health Care : * Plan Needed to Spread Treatment Among UC, Other Hospitals

Last Tuesday, the Orange County Board of Supervisors, responding to pleas for help from UCI Medical Center, finally began the necessary reallocation of spending priorities. It found $3 million to help the foundering hospital meet this year’s budget crisis.

But what about next year? And the year after that? And the year after?

The county board, recognizing that the money is a short-term emergency treatment and not a long-range cure, made it clear that its action was in no way a commitment. The supervisors emphasized that the $3 million is a one-year-only allocation, that the county cannot be counted on for similar adjustments in the future and that it has its own serious budget problems to resolve. To be sure, it does. But so do many other counties, like neighboring San Diego, which historically have been allocating a greater percentage of tight budgets to support health care for the indigent than Orange County does.

What the supervisors must not lose sight of is that conditions at the medical center represent one of the county’s budget problems. It is county government, not the UC campus, that has the legal responsibility to provide medical care for the community’s so-called “working” poor. Those are county residents who are especially vulnerable to untreated medical ills because they have no health insurance coverage and find themselves caught in the Catch-22 condition of earning too little to pay for medical care but too much to qualify for state or federal medical funds.

The medical center treated 10,000 of those “working” poor patients last year, losing $10.9 million in the process. Its losses this year are expected to be even greater.

The shortfall in state and county funds is not the only reason for the hospital’s operating loss. Another major factor is the highly disproportionate share of indigent patients that the medical center treats, compared to the other hospitals in the county.

The additional $3 million that the supervisors gave the medical center, though welcome, doesn’t begin to resolve the problem for the university, or the other hospitals that will get none of the emergency appropriation.

What is still needed, desperately, is for the county to devise a system, as sought by the university, that more equitably distributes the indigent patient load among all the hospitals in the county. In that way, no one hospital would be forced to bear the kind of unequal burden that the UCI Medical Center has carried for so long.

Once that system is created, the state and county must get its priorities in order and provide enough money to make the indigent health care treatment plan really work. Until that happens, the hospitals and the overall health of the entire community will remain at risk.