How to Balance Health Care Budgets: Close Hospitals

It appears Cook County has a plan to make their struggling health care system solvent - close hospitals:

Most controversial in the new strategic plan is a proposal to convert Provident Hospital and Oak Forest Hospital into large outpatient centers, a move that could endanger jobs at the two underused medical centers and that has drawn strong union opposition.

"Our concern is that people won't have access" to needed hospital care, said Christine Boardman, president of Service Employees International Union Local 73, which represents 1,500 workers in the health system.

The situation surrounding Provident Hospital — a pioneering African-American hospital with deep roots on the South Side — is especially complex. If negotiations under way over a possible relationship with the University of Chicago Medical Center are successful, the institution would remain largely intact.

But those talks have been rocky. If they fail, the proposed strategic plan would significantly scale back services at Provident, which would keep its ER open and retain a few dozen hospital beds for patients who need to stay overnight.

The county began the process of closing Oak Forest's long-term care unit several years ago. The fewer than two dozen patients who remain would be placed in nursing homes and rehabilitation facilities under the plan; the facility's ER and hospital beds would close.

"That concerns us because this is an area where medical needs are growing," said William McNary, co-director of Citizen Action/Illinois.

Foley acknowledged that to take care of county patients, "we would really need to build relationships with other hospital providers" on the Far South Side.

Granted, hospitals lose money, and while closing hospitals will save money, it is interesting to note where the patients at those hospitals are planning to be sent:

The county began the process of closing Oak Forest's long-term care unit several years ago. The fewer than two dozen patients who remain would be placed in nursing homes and rehabilitation facilities (emphasis mine) under the plan; the facility's ER and hospital beds would close.

Further, there might be a little flaw in the logic about cost savings with moving to the more lucrative outpatient service model:

"There will be considerably greater convenience for most patients," said David Dranove, professor of health industry management at Northwestern's Kellogg School of Management. But costs don't necessarily plummet when a hospital is converted to outpatient care, he said.

What we're seeing is a planned shift of moneys from the state government dole to the nation's government dole as plans are underway to offload state's health care obligations to the US government as a whole.

The only problem is, when too many patients leave the local government's hospitals for greener pastures, those cornerstones of public health will struggle to survive as patient volumes (and US government payments for services via Medicare and Medicaid) dwindle:

Hundreds of thousands of poor, uninsured adults — the county health system's core clients — will gain insurance cards and the ability to choose medical providers for the first time in 2014. If large numbers of people elect to leave the county health system, that could prove devastating. "We've got to improve our services and improve our infrastructure or we'll lose a large part of our patient base," Foley said.

Which all goes to show: quality, quality, or low cost of healh care - pick any two.

-Wes