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Study: Patronage bad for county's health

Tuesday, August 08, 2006
Chicago Sun-Times
by STEVE PATTERSON Staff Reporter

Cook County runs an "archaic" health system set up to allow "a clear opportunity to use the system for political hiring," according to an analysis released Monday.
The six-month study by the Institute for Health Care Studies at Northwestern University notes that most health-care officials interviewed complained the Cook County Bureau of Health had too many patronage workers in key positions for it to operate effectively or efficiently.
That is among a number of problems facing the $926 million bureau, which is in drastic need of an overhaul in the way it delivers health care to the poor and uninsured, it says.
COOK COUNTY'S HEALTH SYSTEM BY THE NUMBERS
$926 MILLION
The amount Cook County spends on health care for poor and uninsured.
160,000
Number of people visiting Stroger Hospital's emergency room this year. Another 750,000 will visit county clinics.
70 PERCENT
The share of patients at all emergency rooms and clinics who are uninsured.
$302 MILLION
"Bad debt" or unpaid bills written off by the county; three times the amount in 1994.
$54.6 MILLION
The shortfall in expected patient fees for the Health Bureau so far this year. Stroger Hospital alone has collected $38 million less than expected.
STUDY'S PRESCRIPTION
The Northwestern University study provided an action agenda to improve the Cook County Bureau of Health. It includes:
•  Creation of a public/private commission to help restructure the bureau and assess its effectiveness and efficiency.
•  Make bureau leaders explain how they will make up for cuts in Medicaid reimbursements.
•  More effectively serve the growing immigrant and poor population in the suburbs by re-evaluating placement of clinics and programs and partnering with private hospitals.
•  Evaluate the bureau's share of property taxes and whether it would function better under a governing board separate from the county board and president.
•  Budget for needs and demands, free from countywide hiring freezes.
•  Develop an operational priority agenda, regular report cards to target and chart progress.
How to give budget a quick trim
The Cook County Bureau of Health spends $926 million a year providing services at four hospitals and dozens of clinics, with $473 million going to salaries for 7,910 employees.
Commissioner Roberto Maldonado once said as much as $130 million is spent in duplicate jobs. Commissioner Forrest Claypool successfully pushed through an order to consolidate many jobs, saving more than $8 million a year, but the edict was ignored by then-President John Stroger. Among the bloat critics point to:
•  Seven separate administrative departments, 73 people at a cost of $6.8 million.
•  Six separate human resources departments, 35 people at a cost of $2.1 million.
•  Six separate finance departments, 27 people at a cost of $1.6 million.
•  Four separate public relations departments, 11 people at a cost of $468,000.
That overhaul, the report adds, should include oversight from a panel other than the Cook County Board and hiring decisions made by someone other than the County Board president -- a one-person hiring process unlike any other system in the country.
Citing a "pending crisis that will require leadership" to fix, Institute director Dr. Kevin Weiss said consultants should be hired to help the county fix problems in need of being immediately addressed.
The report notes the growing demand for services and shrinking federal resources, but also calls for the bureau to develop a long-term financial strategy, partnerships with private hospitals and budgeting to meet needs.
Claypool applauds report
Commissioner Forrest Claypool, the most vocal critic of county health operations, applauded the findings.
"We can't afford to maintain this giant, political patronage empire, this bureaucratic wasteland, at the expense of the working poor," he said.
The report was prepared without any cooperation or support from health bureau leaders or then-Board President John Stroger, it notes.
Board President Bobbie Steele said she is preparing to take many of the steps recommended in the report during the four months she'll serve.
The report, described as "a call to action" by its authors, says that without change, "a serious disruption" could occur in the quality of care.
Dr. Whitney Addington, who also assisted with the report, cited "a number of urgent concerns," adding "disease and suffering will follow if the concerns raised in this report are not addressed."
Cut waste or raise taxes?
Weiss said property taxes might need to be increased to fund those changes, but the county first needs to study whether they are "optimizing current revenue."
Patricia Terrell, of Health Management Associates, said virtually every other public agency running hospitals has given up control to a separate hospital district, with a board made up of health-care experts -- among the items Addington said the board should address at a special board meeting this month.
"This is preventative medicine," Terrell said. "This is preventing a crisis."


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