Starve and Sever

Is the Mayor Trying To Get Out of the Hospital Business?

Ultimately, what stopped the deal was concern that under new management the hospital would abandon care for the poor. Advocacy groups successfully sued the city, arguing that, because the for-profit company would not have been subject to the same requirements to treat all patients, the city was sidestepping its responsibility to the poor. The Coney Island plan was ''putting health on the stock market,'' says Marshall England, president of the Commission on the Public Health System, which opposed the deal. England is not necessarily opposed to all forms of privatization, but sees the Coney Island deal, like the more recent ''starve and sever'' approach, as attempts to back away from the hospitals' mission. ''We have a mayor that's still committed to eliminating the public system,'' says England. ''Once you do that, there is no system in this city that is mandated to provide services for everyone.''

While the Giuliani administration seems to have lost interest--or perhaps hope--for the outright sale of city hospitals, the idea of privatization on some level is still very much in favor at City Hall. HHC has appealed the Coney Island ruling and Marcos says that having a private entity run a public hospital can be ''a creative way to make significant changes in very competitive times.''

But creativity may not be enough to turn treatment of the city's poor into a money-making proposition. Because of increased rates, many medicaid recipients--currently the public system's main source of revenue--are being wooed away by private hospitals. Marcos estimates that city hospitals see about 1400 fewer patients each day than they did five years ago, and are expected to lose more patients when managed care becomes mandatory for all medicaid recipients within a year. Meanwhile, the city's uninsured population has soared to 1.8 million. And, while hospitals provide the bulk of care to the uninsured, they only get about a quarter for each dollar they spend on them. The effect that financial strain has had on hospitals and patients is unclear, even to those close to the system.

David Jones, a Dinkins-appointee who served on the HHC board until he was replaced by a Giuliani appointee in March, said even board members don't have information about the true state of HHC. ''The board hasn't been privy to any in-depth data for two to three years,'' says Jones. There are anecdotal reports that waiting times in outpatient facilities are high; at Morrisania's dental clinic, for instance, 2500 patients wait up to 18 months for an appointment. And residents at Lincoln Hospital say patients sometimes wait for more than three hours for scheduled outpatient visits. But while HHC promises a comprehensive survey of the hospitals is underway, no such information is available now.

At one time, hospital accreditation reports might have been a good way to gauge conditions. But recently, the accreditation process itself has been privatized, with the inspections now being carried out by a hospital-funded organization instead of the Department of Health. Critics charge that the new private accreditation process, which almost every hospital passes with ease, is less meaningful and tainted by conflict of interest because it is the hospitals themselves that fund the accreditation organization. This year, Public Advocate Mark Green issued a report charging, among other things, that hospitals hire additional staff just to prepare for the new inspections. HHC's Marcos dismisses Green's report as ''a piece of junk,'' but doesn't deny the charge. Even though the hospitals prepare for the inspections (''Don't you prepare for an exam?'' asks Marcos), they pass, which he says shows that the hospitals are in good shape.

Research: Sam Bruchey

This is the first of three articles on the status of public health care in the city.

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