SUMMARY:
Overview
The health and well being of all County residents lies at the core of our mission to serve the public.

Our County population is expected to hit 3.9 million by 2020. The most recent statistics indicate that more than 686,000 residents in the region receive Medicare or Medi-Cal and it is estimated that more than 500,000 are entirely uninsured. Although difficult to estimate, anecdotal evidence points to thousands more who may be underinsured. Additionally, our location along the U.S./Mexico border results in the region’s hospitals bearing the cost of uncompensated care for a sizeable number of undocumented immigrants. Combined with the growing and aging of our local population as a whole, our region faces an enormous challenge of maintaining adequate trauma, emergency, inpatient and outpatient services that are affordable and accessible over the next two decades and beyond, especially for the working poor and indigent.

Today’s action would build upon the past leadership of the County to conduct a first-of-its-kind long-range needs assessment and analysis of the future inpatient, outpatient, emergency and trauma care needs of the region, focused on where and how these services should be provided over the next 10-20 years.

Recommendation(s):

CHAIRMAN RON ROBERTS:
1.     Direct the Chief Administrative Officer to develop a needs assessment and analysis of inpatient, outpatient, and emergency care over the next 20 years, specifically for the region’s working poor and indigent, as well as where trauma centers will be needed.

2.     Direct the CAO to report back to the Board of Supervisors in 180 days with a status report on the progress of the needs assessment and analysis.

Fiscal Impact:
There should be no impact upon the FY 04-05 Operational Plan. Costs should be met out of current appropriations and fund balance.

BACKGROUND:
Individual health care providers perform their own resource planning to ensure their goal of their continued viability. Recently the University of California at San Diego (UCSD) has unveiled one such plan, its “21st Century Vision.” UCSD currently serves a substantial number of the region’s poor and uninsured residents, some 124,000 patients a year who depend on services at their acute care hospital in Hillcrest. UCSD has proposed closing its Hillcrest Hospital and relocating its trauma center and in-patient beds to an expanded Thornton Hospital in La Jolla, leaving a free standing emergency room as one of the main functions of the Hillcrest campus.

We need to better understand how UCSD’s proposed trauma center and hospital relocation and closure will impact the accessibility of health care region-wide and affect the capacity of other facilities to absorb patients. This also raises the issue of where and how patients who live in Central and South San Diego County specifically will be affected by the relocation of hospital beds. We are also concerned about how trauma patients will be impacted by having only one of the five adult trauma centers south of Interstate 8 remain open, when over 40 percent of the region’s trauma patients originate from this area.

The health and well being of all County residents lies at the core of our mission to serve the public. Working to ensure that low-income residents can access appropriate and affordable healthcare is critical to that mission. In order to continue our efforts, we must understand how a growing and changing population will access inpatient, outpatient, emergency and trauma services in the health care system as it will exist over the next 20 years.

The County provides a medical care safety net through a number of programs including County contracts with private hospitals and physicians through the County Medical Services (CMS) program to provide inpatient and emergency room care to medically indigent patients. Specialty care is provided through a network of specialists under contract with the County. The County also contracts with (UCSD) primarily for emergency room care and some inpatient care.

Primary care is provided through contracts with community clinics at sites across the County for low-income individuals and those not eligible for CMS or Medi-Cal through a sliding fee scale. The County operates a number of public health clinics, although they do not provide treatment for people with illnesses and injuries. Additionally, the County has responsibility for establishing eligibility for the State’s Medi-Cal program.

Furthermore, the County plays a fundamental role in the way that the region’s hospitals deliver care to their patients by shaping the region’s trauma system and by designating local hospitals as trauma centers. On February 12, 2002 (19) the Board conducted a comprehensive assessment of that trauma system to determine its stability.

Our County population, currently larger than 20 states, is expected to hit 3.9 million by 2020. The most recent statistics indicate that more than 686,000 residents in the region receive Medicare or Medi-Cal and it is estimated that more than 500,000 are entirely uninsured. Although difficult to estimate, anecdotal evidence points to thousands more who may be underinsured. Additionally, our location along the U.S./Mexico border results in the region’s hospitals bearing the cost of uncompensated care for a sizeable number of undocumented immigrants. Combined with the growing and aging of our local population as a whole, our region faces an enormous challenge of maintaining adequate trauma, emergency, inpatient and outpatient care services that are affordable and accessible over the next two decades, especially for the working poor.

As our population changes, the nation’s healthcare industry itself has also changed to meet its needs. Hospitals are focused more now on outpatient care than they have been in the past. Policy changes, rising costs and low reimbursement rates by the federal and state governments for Medi-Cal and Medicare have also contributed to the rapid growth of managed care and other adjustments to the delivery of traditional health services. Additionally healthcare costs have been impacted by the cost of retrofitting hospitals to meet stricter State seismic safety requirements for inpatient facilities. Despite the fact that so many issues impact the region’s inpatient and outpatient care network, emergency and trauma system as a whole, our region lacks a comprehensive assessment of these needs for County residents into the future, particularly for the working poor and indigent.

Today’s action would build upon the past leadership that the County has demonstrated to conduct a first-of-its-kind long-range needs assessment and analysis of specific health care needs of the region and report back to the Board of Supervisors in 180 days on the progress of obtaining those results.

The needs assessment and analysis will examine demographic shifts over the next 10-20 years and how those changes stand to impact the availability and accessibility of the region’s network of inpatient, outpatient, emergency and trauma care particularly for the indigent health care system and for low-income and uninsured residents. Essential to the analysis will be an examination of where and how inpatient, outpatient, emergency and trauma services are delivered with relation to transportation projections throughout the region. When complete, the analysis will provide objective information that will allow the County to accurately assess how indigent patients and the working poor will be affected by proposed changes in the health care system, such as what impact the proposed relocation of UCSD’s Hillcrest hospital will have on these patients living and working in Central and South San Diego County.

Respectfully submitted,

Greg Cox Supervisor, First District

Ron Roberts Supervisor, Fourth District