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Monday, Dec 4, 2023

Providing Care to Uninsured Remains a Challenge

County Supervisors’ Plan Would Allow Greater Access

Local experts say San Diego’s leaders and health care providers will be faced with greater challenges in the years to come.

But they agree the county Board of Supervisors’ recent approval to fund a plan allowing San Diego’s rising number of uninsured access to the local health care system marks a major step in the right direction.

The majority of the health care industry officials responding to the 10th Annual Deloitte & Touche/San Diego Business Journal Economic Outlook Survey foresee the health care economy in 2000 as faring no worse than in 1999. Out of five respondents surveyed, three believe the health care industry will be “about the same” in 2000; two said “it will be better.”

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But some health care leaders in San Diego are a bit more reserved. Their outlook on the overall industry is bleak.

Four local health care experts agree the challenge to provide quality health care for some 600,000 uninsured San Diegans will continue.

Last year, hospitals and health care providers operated on a shoestring budget, the experts said, as a result of low reimbursement rates from insurers and the government for providing care to the poor and uninsured.

In 2000, it will be worse, the experts said.

“In California the economics for the health care industry is going to be worse,” predicted Gary Stephany, president and chief executive of the Healthcare Association of San Diego and Imperial Counties. “Unless we can get our fair share from the state, the federal government and health plans, our infrastructure will crumble.”

Judith Yates, the association’s vice president, said California hospitals have been operating at a 50 percent loss since 1994.

“In 2000, more hospitals will experience a negative operating margin. Every hospital will be faced with whether it can afford to stay in business,” she said.

Indeed, the restored Medicare cutbacks that were part of the Balanced Budget Act of 1997 will not be sufficient, Stephany said.

“I know of one hospital system (that comprises six hospitals) where the Balanced Budget Act will cost them $15 million in 2000,” said Stephany, declining to name which system.

He added, “El Centro Regional Medical Center in Imperial County will lose about $1 million in 2000.”

Both Scripps and Sharp Healthcare operate six hospitals in San Diego.

But hospitals aren’t the only ones struggling.

Dr. Robert Hertzka, president of the San Diego County Medical Society, predicted at least one major San Diego independent physician association will fall victim to inadequate reimbursement rates in 2000.

In 1998, two large medical groups , San Diego-based FPA Medical Management Inc. and MedPartners Provider Network in Alabama , went bankrupt, forcing many patients to switch doctors and cause doctors to fight for their paychecks.

The Board of Supervisors’ approval of a three-year spending plan allowing San Diego’s underprivileged greater access to health care, create a regional cancer center, and provide money for education programs, signifies a long-awaited shift in attitude by local leaders, the experts agreed.

“In the past years, political leadership has been more focused on safety issues , how we manage the police force and jails,” Yates said.

Added Hertzka, “The county is demonstrating an unprecedented interest in addressing problems of the underserved and we are look ng forward to working with them.”

Ruth Riedel, chief executive of the Alliance Healthcare Foundation, which provides access to health care for the underserved, also praised the supervisors for their support.

Still, the experts said, the local health care crisis is far from over.

Many said they weren’t surprised by the respondents’ slam of local political leadership. The survey’s respondents offered a unanimous “dissatisfied” rating. Those interviewed agreed San Diego’s health care system is in desperate need of an overhaul.

“Our safety net is in danger , we’re doing something about it, but we’re behind the curve,” Yates said.

Riedel said San Diegans need to face their critical public health issues, such as substance abuse, which is often accompanied by the spread of communicable diseases, and a lack of treatment centers for drug users.

Local experts agreed, resolving San Diego’s uninsured problem tops the list. San Diego has the highest uninsured rate in the state and is among the highest in the nation.

The struggle to get funding from federal and state governments to keep hospitals and other health care systems running continues in 2000, Stephany said.

Meanwhile, California hospital administrators are watching helplessly as more doctors, frustrated by managed care, are moving to other states that have less-flawed health care systems.

Not only that, Yates said, today’s shortage of skilled health care providers and hospitals’ struggle to recruit new providers in light of an aging population will get worse, she said.


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