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Addressing Health Care Access in Sonoma County-- 2007-08. Presentation at Sonoma State University: March 3, 2007 Gil Ojeda, Director CA Program on Access to Care University of California Office of the President. Point of View. 35 years in health care delivery and research
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Addressing Health Care Access in Sonoma County-- 2007-08 Presentation at Sonoma State University: March 3, 2007 Gil Ojeda, Director CA Program on Access to Care University of California Office of the President
Point of View • 35 years in health care delivery and research • Past national, state-level and community advocate • Advisor to the Legislature and the University; past advisor to community groups and public HMO’s • Analyst in the health sciences, public policy and the competitive marketplace • Resident of Sonoma County since 1995
Elements of California’s Health Care Marketplace • Regional market issues: “most health care is local & regional” • Rural & urban imperatives: “most problems & their solutions are situational” • Public & private sector roles: “there’s a fabric of relationships & conflicts; dialogue is key” • Regulation vs. market competition: “continuum from the prison to the jungle to the game preserve” • Delivery of care & the public’s health: “driven by demand, but limited by resources” • Diversity & Age: “California’s minorities & the aged often generate program imperatives”
The Art of Public Solutions • Allocation of public resources : “driven by public budgets, private roles, profits & political advantage” • Relative power of constituency groups: “health plans, providers, employers & healthcare advocates” • The Governor & the Legislature: “the Governor is now the leading player since he has acted” • Natural allies & strategic partners: “must be guided by common goals, opportunities, and intentionality”
Federal Support: the Post Nov ‘06 Change in Posture to ABC: “Anything but California” • Coming debates on Medicaid & Children’s Health Insurance (S-CHIP): “funding authorizations, overlapping mandates & a rush to reduce entitlements” • Changes to Medicare: “proposed rate reductions, prescription drugs plans, & the shift to managed care” • Access to care for underserved: “more community clinic support, higher likelihood of direct support for uninsured”
The Coming Storm? California’s Leading Edge Healthcare Issues • Increasing cost of employer based coverage: “increased premium inflation, economic slowdown, expanded self & temporary employment” • 6.5 million uninsured: “is increasing again; public solutions being debated” • Ethnicity and income-driven disparities: “California’s diversity & the unemployed as key factors in health outcomes” • Managed care/HMO’s: “Many are doing well by avoiding risk & competition; in a balancing act for State collaboration and oversight” • Physicians and hospitals-at-risk: “lower reimbursements, higher financial risks, system inefficiencies” • Nursing and specialist shortages: “still out of control, worsened by recent policies; few short-term, some long-term solutions” • State budget deficits: “last year & this year, may compromise efforts to expand coverage to millions of uninsured”
Health Care Reforms: County Roles in Expanding Coverage • Healthy Kids programs implemented throughout state including in this county • Board appointed task force considering stand-alone or multi-county options for managing all Medi-Cal enrollees • Sutter inpatient closure places current County indigent care arrangements in jeopardy. Can Memorial Hospital step up? • Continued loss of physicians from county jeopardizes any efforts to preserve or expand health care coverage. • State level, “shared pain”, effort to bring local low & middle income uninsured, including undocumented, under coverage has chance for passage in 2007-08. Will county's public and private sectors be ready? • Cooperative dialogue among the various sectors, including Kaiser Health Plan, offers best hope for county's successful expansion under framework of new state reform plan
Considerations as We Go Forward • What part of the problem are we trying to fix OR do we think we can fix it all? • Who are the natural institutional allies for health care reforms or are consumers, employers & other health care advocates ready to go it alone? • What can we do locally in the short term? • How can we leverage State & federally mandated changes?