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Steele has healthy chance to implement reform

Friday, August 11, 2006
Chicago Sun-Times

A study this week detailing the problems with Cook County's public health system and laying out an agenda for improvement couldn't have come at a better time. John Stroger, who long resisted reforming the system and, for whatever reason, wouldn't meet with the study's authors, is no longer County Board president. Bobbie Steele is filling out his term, and the report gives her a golden opportunity to leave her mark in the four short months she will be sitting in the president's chair. The six-month study by the Institute for Health Care Studies at Northwestern University concluded that Cook County is facing an impending crisis thanks to a variety of factors. Those include decreases in Medicaid revenue, growing demand for care from uninsured and underinsured people, escalating costs, new regulations that will require changes in how care is given and documented, and the inability of other area not-for-profit hospitals to pick up some of the growing demand. The report also says Cook County is ill-equipped for the challenge thanks to its archaic governance structure and patronage. The county health system still is overseen by the County Board -- unlike most public systems, which are now run by health care experts -- and gives the board president too much authority over hiring, presenting a clear opportunity for favoring political workers over people who actually know what they are doing. More evidence of the Bureau of Health's problems surfaced Wednesday, when Steele acknowledged that auditors were finding unpaid bills dating back to 2003. They had apparently been stashed away to help make the books look balanced. With so much authority vested in the president's office, Steele can immediately adopt some of the report's key recommendations and perhaps build a strong foundation for change. For instance, she could unilaterally create a human resources department for the bureau and let it make all hiring decisions, ending patronage hiring. She and the board can also create a blue-ribbon commission that would help restructure the health system's governance; establish performance measures to gauge how well it is meeting health care goals; develop a financial strategy, including analyzing the adequacy of the local tax subsidy; assess work force needs and coordinate a community forum on health care issues. The report also lays out a variety of other recommendations to help the system meets its growing challenges. Steele seems receptive to the report, promising to adopt many of the recommendations. She said Wednesday that "radical changes need to be made." This is a grand opportunity for the county to reform a system long in need of it. Let's hope they don't blow it.

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