Cook County Bureau of Health is Not the Only One

Almost absent from the discussion about County budgets and safety net health care is the realization that community health centers are a big part of the picture.  In the Chicago metro area, community health centers (CHCs) take care of 500,000 individuals, regardless of their ability to pay; in Illinois, we care for almost 1,000,000;  in the US 16,000,000. 

According to the Illinois Primary Health Care Association, community health centers in in Illinois provide cost-effective care. Health care costs for CHCs are an average of 30% lower than other providers serving the safety net population.  CHCs save dollars spent on unnecessary emergency room care and through the lower use of specialty and in-patient hospital care. With 268 primary care sites in Illinois, over half of those in the Chicago metro area, CHCs are a decentralized solution to primary care delivery.

Cook County leadership should recognize the critical role played by CHCs.  By collaborating on health care services for the under-served, CHCs  save the County dollars while improving the overall quality of care.

Important collaborations between the Cook County Bureau of Health Services and CHCs already exist but are at risk of being cut due to the County's budget crisis.  CHCs may no longer be able to accept referrals to provide primary care to patients released  from County facilities such as Stroger Hospital's  ER if the County cannot provide specialty care for CHC patients in exchange. Ditto for County's provision of pharmacy services for those County patients enrolled for ongoing care at CHC who have the most complex of chronic illnesses.

Only visionaries in health care policy and planning who have a sharp financial accounting pencil currently see the tremendous potential synergy between CHCs and the Cook County Bureau of Health Services.  The Bureau is not the only one out there providing safety net health care and needs to stop acting like it is.

Who should run health care in Cook County?

Who should govern the Cook County Bureau of Health Services?

The current rubric gives the Cook County Board responsibility for oversight of public health and health care. We need experts who know how to run hopsitals and clinics. Most experts agree that the Cook County Board must relinquish oversight to an independent health commission. This is not new news. Earlier this year health experts, under the umbrella of Northwestern University's Feinberg School of Medicine came together and recommended this.

You can read the whole report from Northwestern University’s Feinberg School of Medicine about important priorities and directions that can be taken by Cook County Bureau of Health. The authors of this report should know. They are all veterans of the Cook County Bureau of Health Care system. They have worked there. They know the inside information. There are successful models from around the country that they draw upon in the recommendations section.


Not to be left out, Cook County Board President Stroger appointed his own Blue Ribbon Commission. Read the Blue Ribbon Commission Report to get a sense that we run health care in our County as if it was some feifdom from the middle ages. Time to turn it over to the experts in hospital management, public health systems and financial outcomes. We'll see if President Stroger has the political courage to follow these recommendations.

Death and Health Insurance

This column by Bob Herbert column by Bob Herbert in the NY Times got me thinking about the relationship between health insurance and what physicians write on death certificates. Does lack of health insurance increase the risk of death?

This letter was not published, but 2 by others took a different approach.

November 3, 2007

To the Editor:

Re “Worsening the Odds” (Op-Ed, Nov 3): Bob Herbert describes the unfortunate case of a 45 year old medically uninsured craftsman with progressive headaches who died of metastatic cancer to the brain. He suggests that lack of health insurance contributed to the cause of death.
At our inner-city community health center, 70% of the adults we serve lack health insurance. We commonly see preventable complications of disease.
In Illinois, physicians must enter the official cause of death on the death certificate. On the following two lines physicians may choose to add that the death was “Due to or as a consequence of …” Perhaps we should routinely write “lack of health insurance” or “inability to obtain preventive care” on these lines. By doing so, the role played by this important factor will become an official part of the public record.