At the start of the 1995-96 fiscal year, Los Angeles County was faced with an unprecedented $655 million budget deficit in health services-the loss of one out of every two health dollars previously available-and a devastating collapse of the health care safety net. In response, State, Federal, and County officials collaborated to develop a five-year Medicaid Demonstration Project to address the County's structural and fiscal crisis. The Project focused on moving away from expensive hospital-based services toward community-based primary and preventive care services.
Restructuring a public health system is a very involved undertaking, with numerous factors contributing to the challenge. Furthermore, the magnitude of the health issues faced by the County compounded the challenge of transitioning the County's large, fragmented health system into an integrated, comprehensive inpatient and ambulatory care system. Under the current Demonstration Project, the County has made significant structural changes and seeks to continue that process by moving toward managing disease and patient care.
The next phase involves expanding ambulatory care, integrating public and private providers, and changing fiscal disincentives and long-standing clinical practices. This will require both time and resources.
The County proposes to institutionalize funding arrangements for successful programs/initiatives (e.g., ambulatory care expansion and clinical resource management processes), as important policies in addressing structural and funding issues.
The complexity of current funding streams and priorities calls for interagency and intergovernmental planning and problem solving to address long-term financial and structural needs of the County's safety net, which will be addressed in this paper.
Learning Objectives: Identify the health care reform issues faced by public health systems when undergoing transformation. Assess the key progress indicators when evaluating progress toward system restructuring. Discuss the key areas of reform impacting public delivery systems the financing issues necessary to institutionalize successful restructuring programs/initiatives. Describe the key policy strategies needed to institutionalize funding streams to support long-term restructuring strategies and system evolution (e.g., from a heavily focused inpatient delivery system to one focused on outpatient/ ambulatory care delivery strategies)
Keywords: Health Care Access, Restructure
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.