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Monday, Sep 25, 2023


There is an old, somewhat cynical adage that bad news sells and good news is advertising.

Certainly, bad news seemed to predominate in articles about the meltdown of Los Angeles County’s health care system. But I am compelled to point out the good news: In early February, the Los Angeles County Board of Supervisors approved the final round of contracts for public-private partnership agreements that will effectively expand access to community-based primary care services throughout L.A. County.

The County has finally realized that there must be an integrated system of health care, and to make that happen it must work with local primary care clinics.

The uninsured working poor have, until now, been caught in a no-win situation that is not of their own making. Here’s how health care in poor neighborhoods used to work:

Just getting an appointment to see a doctor could require many phone calls to different clinics for an uninsured worker or his or her dependent. After getting lab tests, x-rays, a physical exam and other necessary procedures, he/she was referred by the primary care physician to a County Hospital for specialty care, if necessary.

The patient then went directly to an emergency room the only access for the uninsured, but the most expensive option to the taxpayer (the average cost of an emergency room visit is $550 just to walk in the door. Physician services, lab tests and x-rays add to that cost.) In the emergency room, the patient might wait almost a whole day before being seen.

After another interminable amount of time passed three months or more on a waiting list the patient was finally treated in the specialty clinic, and frequently the same lab tests, x-rays, and exams were repeated, because no records of the previous workup existed in the County’s system. Then the patient went back to the community clinic for follow-up and ongoing care.

Again, no records from the County accompanied the patient, so the primary care physician in the community clinic was dependent on the patient to describe the treatment received.

The situation was a nightmare for the patient, an exercise in frustration for the doctors in both the primary and specialty care clinics, and an expense for the taxpayer. But that has changed. Now, with the public-private partnership contracting with the primary care clinics in the community, the county will take referrals into its specialty care clinics without forcing the patient to go through the emergency room.

When a patient is referred to a specialty clinic, his or her records will be available; there will be no long wait for treatment and no duplication of services. When the patient returns to the community clinic for maintenance, records will again be transferred. People who don’t know where to go can call one number to get the location of the clinic closest to their homes.

A no-win situation has been turned into a win-win situation.

L.A.’s free and community clinics have always been committed to treating patients compassionately yet cost-effectively. In order to respond to the growing numbers of uninsured working poor the most recent estimate is that there are 2.7 million people without health insurance in Los Angeles County (most of them low-income working Angelenos) we have looked at ways to extend our services by adding staff, adding hours, and/or adding sites.

Our partnership with the Los Angeles County Department of Health Services will help us meet the increasing demand for low-cost primary care and efficient specialty care. Now that all 45 contracts have been signed, the expansion of services can begin. The public-private network now includes 116 primary care sites countywide.

Questions remain, of course. Will the primary care clinics be overwhelmed by patients? Will some geographical areas be neglected? Although the clinics will receive some reimbursement from the county, will they be able to raise the additional funds needed to support the expansion of services? How quickly will a population that has relied heavily on hospital emergency rooms for access to care transition to community-based care?

Los Angeles County still faces hard budget choices in the health care arena. But the county should be praised for taking this first, very important step. The door to change has been opened and cannot be slammed shut.

The county and the community clinics have always had a shared mission and have frequently shared patients. Now they have jointly committed to increasing access to primary care and integrating services, patient information and community-based planning to ensure the high-quality care that low-income residents deserve. This is good news, indeed.

Mandy Johnson is executive director of the Community Clinic Association of Los Angeles County, which represents 23 free and community clinics in L.A. County.

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