Wednesday, October 24, 2007
Chicago Tribune
by Mickey Ciokajlo

Cook County's cash-strapped health system is considering charging co-payments for patients treated at its community clinics, emergency departments and the jail, much as it does for prescriptions at its pharmacy, officials said Tuesday.

The pharmacy co-pays have generated more than $100,000 since they were introduced about two months ago, county health officials said during their budget presentation to the County Board's Finance Committee.

"We have done a survey of other public hospitals throughout the United States and found that we were the only ones that really had no co-payments," said Thomas Glaser, chief operating officer of the Bureau of Health Services. "The first was the pharmacy because we thought that was the easiest to implement."
Dr. Robert Simon, the health bureau's interim chief, said the health system needs to expand co-pays to other areas but officials have no timeline.

He said officials are concerned about a potential public relations backlash.

"It's a tough one," Simon said. "If you guys stand in our shoes and in the board's shoes, the moment we do, say, $20 for a clinic visit ... what will end up happening is you're going to get patients that will say ... 'I can't afford it,' and then it will become a newspaper article."

"We'd never not take care of a patient, but it's very careful how you start that," Simon said. "So, we have to start one, yes. But how we start it and when we start it, it'll be a very delicate program."

In August, the health system began charging $3 co-pays for each prescription filled, up to a maximum of $10 per visit.

After making dramatic cuts to the hospital and clinic system earlier this year, Cook County Board President Todd Stroger wants to add hundreds of health bureau jobs as part of his proposed $3.2 billion county budget that would increase sales and other taxes.

The health system has long failed to collect payment for services, and Simon's team is scrambling to make the system more self-sufficient.

Glaser said past finance officials from the health bureau misled the County Board in 2006 about their ability to bring in tens of millions of dollars in patient fees.

Glaser, who previously served as the county's chief financial officer, said health officials in the past tightly controlled the information that was released.

He said it could take up to three years to fix all the problems.

"It took a long time for the financial operations at the Bureau of Health to deteriorate, and it's not going to be turned around in nine months," Glaser said.