Saturday, January 13, 2007
Chicago Tribune
by Judith Graham

With budget cuts looming for the Cook County health system, a message went out a week ago from headquarters: Stop giving away free services to people from the collar counties.

Though it is not generally discussed, thousands of people who don't live in Cook County--perhaps tens of thousands--get free or deeply discounted medical care every year at its hospitals and clinics.

But when times get tough financially, generosity finds its limits. So, beginning Monday the policy for non-residents seeking medical care became "pay upfront or go without" in all but serious emergencies. Free prescriptions for far-flung suburbanites also were cut off.

That was the way things stayed for all of one week, until the Tribune began chasing down the story. Late Friday afternoon, County Board President Todd Stroger directed health chief Dr. Robert Simon to rescind the policy. Stroger said he had just found out about the changes that day.

"While we do not rule out any option as we rethink the provision of health care in Cook County government, we are not yet at the point when these types of specific proposals have in any way been set in stone," said Stroger spokesman Steve Mayberry.

The turnabout highlights how important Cook County's health bureau has become to the entire Chicago area. Whatever cuts are made at the bureau--Stroger has ordered that the budget be slashed 17 percent--will be felt far beyond Cook County's borders and touch thousands of lives.

The county's hospitals and clinics have long been committed to helping pretty much anyone who walked in the door. When the change of policy came a week ago, it was not announced publicly. The Tribune learned of it from staff, who passed along a Jan. 5 memo from Simon.

"Our concern is that patients who have been receiving care [from the county] haven't been notified and that their care could be disrupted because of these new policies," said a physician who asked not to be identified, out of fear of losing her job.

As of Jan. 8, the memo said, "all patients who present to any of our facilities or clinics must show proof that they are residents of Cook County during the registration process. Those who are not residents of Cook County must be referred to the Public Health Department of their respective counties or they must pay the full price for services."

It also specified there should be "no elective surgeries or procedures without payment upfront for those procedures for non-residents" and that "patients who receive medications and cannot pay ... must show proof of residency."

County officials did not respond to requests for information on how many non-residents are served and at what cost. But budget-cutting was clearly the motivation for the change. In the last five years, more uninsured collar county residents have been turning to Cook County for free medical care, driving up costs.

County a `medical safety net'

"The reality is, the county system has been serving as a medical safety net for the entire region," said Paul Kuehnert, deputy director of the Kane County Health Department.

The medical migration is occurring in part because the other counties have no public hospitals for the hundreds of thousands of residents who lack adequate health insurance. The latest estimate of the uninsured in the region is about 700,000.

Though low-cost clinics have been opening in the suburbs, they usually don't offer much-needed specialty services. Nor do the clinics supply free or deeply discounted medication, as does Cook County. And many people without insurance are reluctant to go to private hospitals for fear of receiving large bills they cannot pay.

The situation means Cook County taxpayers wind up footing the bill for medical services that neighboring counties don't provide. Still, it's difficult for health providers to turn away people in need.

"You can make a reasonable argument that it's only fair that only citizens of Cook County should get free or discounted care from the county health system and citizens from other counties should have to pay," said Victoria Bigelow, president of the Suburban Primary Health Care Council in Westchester. "But this is going to be a big change, because a lot of people from a lot of other counties use Stroger Hospital and the [county] clinics."

Some sources suggested that 3 to 5 percent of appointments at the county's clinics go to non-residents, which translates to 22,400 to 37,300 patient visits a year. Those numbers don't include pharmacy services or hospital care.

Lake County residents made 7,000 clinic visits and 2,400 emergency room visits to Cook County medical facilities last year, according to Dale Galassie, executive director of Lake County's Health Department. He said those numbers come from Cook County.

Warning months ago

Galassie said Cook County officials had warned him months ago that the policy change was coming, well before the urgency of the current round of budget cuts. "What Cook County is saying to the collar counties is, `You need to absorb your people,'" he said, adding, "I think we have adequate resources to do that."

Officials aren't so sure in Kane County, where 1,400 residents made 7,000 visits to Cook County clinics last year. "We're very concerned about what the effect will be," Kuehnert said. Specialty care and free medications aren't yet available in Kane County for the uninsured or underinsured, he said.

In DuPage County, new policies for non-residents could have "a major impact, especially on patients with special needs" and "will create significant new pressures on county health programs," said Dick Endress, president of Access DuPage, a program for people without health insurance.

More than 3,000 patients from DuPage received clinic services from Cook County last year, said Maureen McHugh, executive director of the DuPage County Health Department. She said the potential policy change in Cook would be a major topic at a county health care summit scheduled for Thursday.

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Changing course on who gets care

Cook County health chief Dr. Robert Simon reversed course on a residency requirement.

JAN. 5: "All patients . . . must show proof that they are residents of Cook County."

FRIDAY: "Pursuant to a directive from Cook County Board President Todd H. Stroger, I hereby rescind my memorandum of Jan. 5."