Wednesday, July 14, 2010
Chicago Tribune
by Chicago Tribune editorial staff

The symptoms are troubling: Thousands of impoverished patients rely for their health care on Cook County facilities that don't match their needs and that cost more than taxpayers can sustain.

The prognosis, though, has brightened. Apply the right treatments and everyone could win — the county health system's patients, the underused infrastructure and the taxpayers who pay for it all.

On Wednesday, members of a Cook County Board committee will begin discussing that prognosis, which comes in the form of a consultant's dramatic plan to reform the county's health system. The report proposes:

•Scaling back inpatient services at Provident Hospital, which uses relatively few of its beds. An emergency room and some short-stay beds would remain open.

•Closing inpatient services at Oak Forest Hospital and creating a regional outpatient center that would provide a range of primary care services.

•Consolidating and strengthening services at Stroger Hospital.

•Rebuilding Fantus Health Center, an outpatient clinic on the Stroger campus.

Credit the independent health panel that now runs the county system with a smart, gutsy plan that should promote efficiency and deliver better health care.

The problem here isn't lackadaisical doctors or a lack of will to serve a disadvantaged clientele. The problem is that decades of county politics geared toward patronage hiring created three hospitals, and three big work forces, that a shrinking patient load no longer justifies. The hospitals gobble dollars better suited to supply basic outpatient care.

The challenge is to redeploy those dollars — away from some too-empty inpatient wards and toward decentralized primary care clinics in neighborhoods where patients live. This plan, which the County Board should approve, does just that. Why hasn't that happened before? Because it has been in the interests of politicians to build large pools of patronage employees at the hospitals.

One thing tempers our enthusiasm: The plan projects that when the changes are complete, the system will run deficits similar to today's: The plan envisions a $332 million infusion of cash from county taxpayers in 2015, about the same as in 2010. An overhaul this ambitious should produce great efficiencies.

Health panel officials advise us not to put much stock in those projections. But ignoring the numbers wouldn't be healthy. We think health officials are on the right track, but they've got to control expenses. As reimbursement collections improve and hospital costs ease, the system should need fewer dollars from cash-strapped Cook County.

One way to save: Coordinate with city clinics in Chicago to eliminate redundancies. County system CEO Bill Foley says officials have had "preliminary discussions" and "we definitely want to look at opportunities to collaborate with them." That's a must.

The wild card in all this is the rollout of new national health care reforms over the next few years. It is unclear what that will mean for public health providers. But here's what we do know: Hundreds of thousands of poor uninsured adults — the core clients of the county health system — will gain insurance coverage and more choices about where to get treatment. They'll choose medical competence and convenience, just like everyone else. They won't choose a county system if it can't compete for quality of care and ease of service.

Bottom line: We urge the Cook County Board to quickly approve this plan, because it moves the system in the right direction. But that's not the end of it.

The board rightly handed control of the health system to the panel to get things done. The panel has delivered so far. But the board shouldn't relinquish its responsibility to county taxpayers, to make sure that they, too, get maximum bang for every health care dollar.