Health Care Reform - Cook County Style

As our national health care debate drags on with no clear end in sight, it is possible to take heart at meaningful reforms within Cook County government.

Two years ago, the County Board reluctantly agreed to give up control of the county’s health care system in exchange for the now infamous sales tax increase needed to close a $300 million budget gap. An independent eleven-member governance board was created to oversee the Cook County Health and Hospitals System for a three-year period. PCG, along with a number of other civic and advocacy organizations, had long advocated for an independent board of health care and financial experts.

On February 2 all voters should evaluate the current candidates running for Board President and County Commissioners against their commitment to their support for the board and its continued independence.

In just 18 months the new board can point to significant accomplishments. The board’s first, and most critical step, was to recruit as CEO William Foley, a seasoned health care administrator who receives high marks even from critics of the board.

He, in turn, has put in place a professional leadership team to deal with a nearly $1 billion organization. When he took over, the county health care system had no internal audit function, operated without a general ledger, failed to maximize federal revenues, did not take advantage of purchasing discounts, and could not accurately identify the number and location of its professional and clerical employees.

These massive deficiencies have been largely corrected.

In the first budget passed under the new Board, the County will realize a 19% reduction, almost $60 million, in the use of revenue from Cook County taxpayers over last year’s $382 million supported with county funds. (The remaining $600 million is supported through federal revenue.) This result is a combination of eliminating 450 filled and 500 unfilled positions, increased federal revenue reimbursement, industry-pooled purchasing, and other efficiencies.

The ultimate test of the new independent board is, of course, not efficiency as an end in itself, but whether it effectively delivers quality health care to those county residents who have few, if any other, options for obtaining health care.

Toward this end, the new Board is developing a strategic plan. According to observers, the Board and CEO Foley have shown a willingness to listen to community feedback: they have revised the draft plan and are now holding a second round of hearings.

We must all be concerned about what will happen to the current network of community-based clinics, whether the right kind and number of specialty services will be provided, and how all the pieces of this immensely complicated system will fit together and be accessible to those it is intended to serve.

These are critical matters and will pose difficult challenges as the board develops a strategic plan. As we see continually at the national level, there are few, if any, simple answers to the complexities of health care delivery.

But it is clear that the management of a nearly $1 billion health care system requires a board and staff with the independence to reject the patronage and sweetheart contracts that just 18 months ago — in the hands of Cook County Commissioners — were too often the order of the day.

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