Health Column 23


Public-private partnerships are all the rage in Los Angeles, as the county downsizes its inpatient hospital bed capacity. But one public-public partnership could go a long way towards identifying Los Angeles’ actual health care needs.

The county Department of Health Services and the UCLA School of Public Health have penned a deal to jointly look at the effectiveness of L.A.’s public health programs. The top-to-bottom study will look at a wide assortment of programs from those designed to control the spread of communicable diseases to ones involved in the operation of L.A. outpatient medical clinics.

“We’re doing what I call a zero-based review of our public health division,” said DHS Director Mark Finucane. “Are we properly organized? Are we properly trained? Are we properly deployed? And are we appreciated? Apart from the occasional strawberry scare, do people know what we’re about and why we’re important?”

About a dozen UCLA faculty, led by the school’s former dean Lester Breslow, will review across-the-board operations of public health, minus the sprawling hospital system.

Finucane said that, since taking office in early 1996, he has halted any downsizing in the county’s public health division, but he wants a “complete revamping” of the division.

So what’s in it for UCLA?

“This provides our faculty with a unique opportunity to help improve the health and well being of everyone in Los Angeles,” said Abdelmonem Afifi, dean of the university’s school of public health. The study is “not just a one-time project, but is the beginning of a partnership between the school and the county to improve the health of everyone.”

One possible outcome of the study, Finucane said, would be for the School of Public Health to assume responsibility for a small part of the county, for which the school could create a model health system.

Local lawyer makes good

Gov. Pete Wilson named a former local health care executive to serve as the state’s health care ombudsman, throwing a bone to opponents of his proposal to keep Keith Bishop as head of the embattled Department of Health Services.

Joseph F. Parra, a long-time West Covina attorney who in recent years has been working in Sacramento, was named to the ombudsman position last week. His appointment came just as the Legislature appeared poised to reject Bishop for another term in the $108,000-a-year position.

Bishop’s opponents say he has been too soft in regulating the HMO industry. They had called on the governor to create a permanent ombudsman position to help ensure proper regulation.

Parra is currently an assistant to Bishop, and his appointment does not require Legislature approval.

Before joining the Department of Corporations, Parra served as legislative director of what was then the Hospital Council of Southern California (since renamed the Healthcare Association of Southern California).

Foundation stays busy

Foundation Health Systems, the company formed by the merger of Health Systems International and Foundation Health, said it has reached a definitive agreement to buy Physician Health Services Inc., a 400,000-member health plan serving New York, New Jersey and Connecticut.

FHS said it will buy PHS for just under $30 a share, for a total purchase price of $280 million, which it plans to pay for through cash and bank debt. PHS had 1996 revenues of $482 million.

In other FHS news, co-founder, CEO and all-around top dog Malik Hasan has stepped down as president of the company, but retains his chief executive post and adds chairman of the board to his titles.

Hasan replaces Daniel Crowley as chairman of the board. Crowley was president and CEO of Foundation Health before the merger, and he will stay on as a member of the board of directors and as a consultant with FHS for three years.

Taking on the title of president is Jay Gellert, who retains his pre-existing title of chief operating officer.

No pot-death link

Researchers at Kaiser Permanente say an exhaustive, 10-year study of mortality data from 65,000 men and women has found no correlation between marijuana smoking and death.

The study appeared in the April edition of the American Journal of Public Health.

“About a third of the American population over the age of 12 is estimated to have used marijuana, making it the most popular drug in the country, but we still know little about its long-term health effects,” said Dr. Stephen Sidney, a Kaiser epidemiologist who oversaw the study.

The study looked at 65,000 patients between 15 and 49 who had comprehensive check-ups at Kaiser facilities between 1979 and 1985. The patients were subjected to a battery of self-administered questionnaires, which included questions about their drug use. Mortality statistics were followed for all the respondents until 1991.

In men, the study found marijuana use was only associated with deaths from AIDS. “This doesn’t mean marijuana causes AIDS,” Sidney said. “During the 1980s, homosexual men and bisexual men had a higher rate of marijuana use than heterosexual men.”

The study found no statistically significant association between marijuana smoking and any cause of death among women.

Schizophrenia medications

The California Psychiatric Association has added its voice to those of patient advocates calling for the state to make new medicines for treating schizophrenia available to Medi-Cal patients.

The state currently requires that patients fail to respond to two anti-psychotic medicines introduced in the 1950s before being permitted access to the new pills.

The new medicines are more expensive than the 1950s’ medications, but supporters say lower hospitalization rates associated with use of the newer drugs would more than make up the difference in total costs.

“For some reason, the Department of Health Services is opposed to making these more effective drugs available, even though several independent analyses of the policy have shown it would save the state money, allow more patients to go back to work, and cause fewer side effects,” said Dr. Thomas Ciesla, president of the psychiatric association.

Ben Sullivan is a reporter for the Los Angeles Business Journal and covers the health care industry.

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