Government Must Pay for Care of Indigent

The appearance of officials of UC Irvine Medical Center before the California Board of Regents to explain why it is losing money is becoming a disturbing annual event. It is disturbing to the general community as well as the UC system because in the long run everyone will suffer if the medical center cuts back on the care that should be available to all, whether they can afford to pay for it or not.

UCI officials were before the Regents again Thursday, this time to say they would have to stop treating Orange County’s indigent and working poor except in emergencies. The medical center has been brought to the brink of financial disaster by the shortfall from the state and county, which for years have been avoiding their obligation by paying much less than what it costs UCI to provide the medical and emergency room treatment under the indigent care program.

Last year the medical center reported a $8.6-million operating loss. Its operating deficit is now projected at more than $13 million by June 30, the end of this fiscal year. And next year it could grow to $15 million. The cost of providing medical care has been steadily increasing along with the number of patients who cannot afford to pay their hospital bills. However, state and county reimbursements--to help hospitals meet community health needs without going bankrupt in the process--have not increased.

UCI’s medical center has only 6% of the total hospital beds in the county. But it is treating more than half of the county’s indigent patients. Only about 3 out of every 10 patients have private insurance to cover hospital costs, and the university is reimbursed less than half of what it costs to treat the other seven “public” patients.

So the more poor patients it treats, the more money the medical center loses. And if it seeks more private patients, it must cut back on the number of poor people receiving care. Other hospitals that faced the same dilemma have already taken the action UCI warned it might follow to survive--they shut their doors to Medi-Cal patients except in critical emergencies.

Their closing raises the urgent question of who will treat poor people and those without medical insurance? And how many illnesses, which can be easily prevented or treated and cured, will go unattended until they become medical emergencies? They will involve even greater medical costs--and more lost lives.

The state and county have a legal and moral obligation to treat the poor whom they cannot continue to try to pass off to hospitals. More tax revenue must be raised or spending priorities rearranged to give hospitals more realistic reimbursements and to keep the health-care system from falling apart. Failure to do so puts everyone, rich or poor, insured or not, at risk.