July 30, 2008

Caring for Poor Could Double

By Zachary K. Johnson, The Record, Stockton, Calif.

Jul. 30--STOCKTON -- Without San Joaquin General Hospital, the cost to the county to provide medical care to its poor could more than double, according to a report from county Health Care Services.

It costs the county about $35 million to meet its legal obligation for the medical care of indigents at the hospital, but that cost would range from $33 million to $70 million if the county had to pay someone else to provide medical care to the county's poorest residents, Director of Health Care Services Ken Cohen told the Board of Supervisors at its meeting Tuesday.

Cohen's report was one of two presented on San Joaquin General Hospital at the request of the supervisors, for whom tackling the problems causing San Joaquin General to operate millions of dollars in the red is a priority. The other report provided more detailed information on hospital operations and was the first in a monthly series to be delivered to the board by a consulting group holding key management positions at the hospital.

The report on the indigent population was just more information for the board to consider in its strategic thinking on how to keep the hospital solvent, Cohen said. "This was just another piece of the puzzle."

In Cohen's presentation, the low end of the potential cost to provide for medical needs for the poor, $33 million, assumed the county changes its eligibility standards to someone earning 150 percent of the federal poverty level. The current level in the county is 300 percent of the poverty level, which would work out to about $56,000 for a family of four. But such a move would cut out about 25 percent of the 8,600 county residents currently eligible for the indigent care program and would affect their access to care, Cohen said.

In addition to effects on indigent care, a world without San Joaquin General Hospital would cause "enormous systemic problems" in a local health care system already suffering from shortages. "There's just not the capacity to handle it."

That lack would have the added effect of bumping up costs if the county's obligations had to be contracted out, officials said.

"Since we do not have (excess capacity), we would probably end up paying more," Supervisor Larry Ruhstaller said.

The staff report did not include other elements that could push figures higher, such as additional costs for outpatient care, pharmacy and other services. Nor do the figures include the cost for providing medical services to wards at juvenile hall and inmates at the San Joaquin County Jail, who currently receive medical care through San Joaquin General and the state's prison health care system, according to the report.

"I think today's discussion will lead to other discussions about what we actually spend on indigent health care," Supervisor Victor Mow said.

The day's other report, prepared by the Camden Group consulting firm, had detailed figures -- such as the daily census and average time spent in intensive care -- that can help get a handle on costs and increase the hospital's stability, he said.

Earlier this year, San Joaquin General was expected to run a deficit of more than $20 million. Cost savings have pushed that estimate down in recent months. The county covers the hospital's deficit.

"I'm willing to accept some losses," Supervisor Leroy Ornellas said. "But not at the expense of other county departments."

Contact reporter Zachary K. Johnson at (209) 546-8258 or [email protected]


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