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A good start for indigent care fix

The recommendations for strengthening Hillsborough's indigent health care program strike the right balance between fiscal sanity and caring for the working poor. Commissioner Mark Sharpe's study group proposed a sound business plan that underscores the moral and practical need of providing thousands with basic medical care. The strategy does not fully address the unmet health needs of a growing county, but it is a solid start - the first framework in years for depoliticizing health services for the poor. Commissioners should embrace it when it comes up Wednesday.

The board created the group in March to examine ways to control expenditures of a program now costing $98-million annually. To Sharpe's credit, his committee took more than a meat-ax approach. Many recommendations would improve the delivery of health care services by employing technology, winnowing layers of administration and spending more time ensuring patients and providers are committed to achieving results.

The major recommendation is to refocus the plan on core medical care - services that keep patients from needing costly hospitalization later. This concept is what the county desired when it created the health plan in 1991. By better coordinating care, patients might see their doctors more regularly, making it easier for some to make changes in their diets and lifestyle. The plan also calls for a new disease management program. This makes sense, because chronic diseases, from cardiovascular and breathing problems to diabetes, consume nearly two-thirds of the health plan's budget.

Charging a nominal fee for prescription drugs and requiring patients to take more responsibility for their treatment regimen is reasonable. Bundling services, instead of using a wide network of independent providers, would benefit so long as performance would drive contracting decisions, not simply cost. Another Sharpe recommendation would freeze any changes to the governance of the health plan, which is overseen by a competent board of local health care professionals, for up to three years. That would keep commissioners from playing politics with poor people's health until after the next election. A period of stability would be the time to re-examine how to convert these efficiencies into cash to meet the county's growing health needs.

[Last modified October 4, 2005, 02:15:30]