The Drumbeat on County Health Services

We have seen over the last week or so the development of somewhat of a drumbeat over at the News and Record over anticipated cuts in health spending in Guilford County.  One program at risk is Guilford Adult Health.

The News and Record is correct to protest the secrecy with which the county budget process is taking place.  In fact, candidate for county commissioner Sam Spagnola has taken the same position-- and cited his work on the GPD legal case to back up his claim.

The matter of the cuts, however, is a bit more complicated.

I have some level of knowledge and experience in the field of public health.  My residency training afforded me considerable exposure to this field, and I have an MPH degree.

North Carolina's public health system is remarkable from the standpoint that it attempts to provide primary care services for the poor.  It attempts to be the primary care doctor for those in poverty.  It goes well beyond the traditional mission of public health in this respect.  And as a result, many of our fellow citizens receive primary care, directly or indirectly, through their county health department.

This is not necessarily the case in other states.  In fact, within public health circles, some physicians are fairly passionate that public health departments ought to focus on traditional public health activities-- and not be providing primary care.  I remember that debate taking place when I was in residency.  But my perception is that the system in our state does much more than others. 

In addition, within Guilford County, we have had various programs like Guilford Adult Health materialize that I suspect go beyond what is typically provided in other parts of the state.  My belief is that these programs arose at a time when Guilford County perceived itself to be an affluent area that could afford this level of charity care.  

So we likely have a state that likely provides more primary care than other states; and a county that likely provides more than other counties.  I think we need to understand fully the level of primary care services provided in other areas before we start banging the drum.  I think we need to look at benchmarks, and see how Guilford County compares.

It could be that the changes envisioned by Skip Alston, Steve Arnold and Brenda Jones Fox would still place us above the median of what is provided in county health departments nationwide with respect to provision of primary care.  It could be that they are on the right track, because there is little justification for our county health department to be doing much more than is done elsewhere.

I agree that we should open up the budget process.  But I think we need to look at the data objectively, instead of scaring people over cuts.  The fact is that our county is not nearly as affluent as it used to be.  And to make matters worse, our county elected officials, including Linda Shaw, went on a wild spending spree when they placed hundreds of millions of dollars in bond spending on the ballot two years ago.  The Greensboro Partnership and Action Greensboro were more than pleased to throw their weight behind the bonds.  And now we have a fiscal predicament on our hands.

A couple of county commissioners, including Kirk Perkins and Paul Gibson, appear to be more than happy to raise taxes to avoid budget cuts at the county level.  Let's hope their colleagues do not agree. 

We need to look at any proposed cuts at the county level objectively.  We ought not react based on emotion.  

Comments

[jo]

Joe,

Are you saying we're doing too much for the poor in Guilford County? Good luck winning that debate.

[Joe Guarino]

I am saying that the county and its health department may be delivering and/or facilitating more health services for the poor than may be the usual case in much of the rest of North Carolina, and in other states. If my assertion is correct, and I think it probably is, then it should be taken into account when civic discourse takes place regarding the budget situation.

[buzzman]

I believe that you are correct that Guilford County either directly or indirectly offers more health care services than others in NC.
Although void of all the facts, the N&R article focuses on the possibility that the County may withhold $1.6 million in funding. Wouldn't it make sense for Moses Cone and High Point Regional to provide those funds since preventive care would save them money by eliminating a good number of emergency room visits and care for those who's problems have progressed to being serious?

[Joe Guarino]

Buzz, I think Cone may already be providing some funding. But you are correct that HealthServe and other health services provided through the county theoretically benefits the hospitals by diverting non-paying customers elsewhere; and by making them less prone to be hospitalized at least in the short term.

[jaycee]

Wait...what??
I thought all health care was free now compliments of The Great Messiah. Have I been told a lie??

[Dr. Mary Johnson]

You have been told a lie.

[Roch101]

"I thought all health care was free now compliments of The Great Messiah." -- Jaycee

Are you on drugs? Where did anybody say all health care was now free?

[bubba]

"I thought all health care was free now compliments of The Great Messiah."

Yes, and we won't have to work on paying our mortgages or car payments now. The lady who was interviewed after the Obama campaign rally two years ago said so.

[Brenda Bowers]

In my opinion the county acting as Primary Care Provider for the poor is a good thing and I hope cuts are made elsewhere in the budget. I personally seen the great good this free and low cost clinic have done. Perhaps cuts could be made on Alma Adams art gallery and the other non-profits that do nothing but collect tax payers money. Guilford County and Greensboro has a lot of this "non-profits" it seems to me. Certain people have learned well how to game the system. If they are non-profits then they should get their funding from the private sector not the tax payers. BB

[Bubba]

"In my opinion the county acting as Primary Care Provider for the poor is a good thing and I hope cuts are made elsewhere in the budget."

It won't make any difference when health care "reform" dumps thousands more people in to Medicaid in NC. We'll face an increased burden of 500 million to one billion dollars, and programs like the one discussed here will in all liklihood cease to exist anyway.

[Joe Guarino]

That is a good point, Bubba. But interestingly, in North Carolina, county health departments provide primary care for some patients who have Medicaid.

[michele]

"Buzz, I think Cone may already be providing some funding. But you are correct that HealthServe and other health services provided through the county..."

Joe, some clarity on the relationships:

"2002 - HealthServe Medical Center becomes a department of Moses Cone Health System and a provider in the continuum of care for the newly formed Guilford Adult Health. HealthServe Ministry is dissolved." (source: MosesCone.com)

More on the cuts from a Moses Cone VP: http://chosenfast.com/2010/04/29/moses-cone-vp-tim-clontz-on-guilford-county-health-care-cut/

[Joe Guarino]

Thanks, Michele, for the clarification.