The Southern California Physician, March, 2002

$250,000 Available for Local Uncompensated Physician Care
By Kenneth C. Lane, M.D.

$250, 000 is now available through a special fund created by the San Bernardino County Board of Supervisors to reimburse physicians for uncompensated non-emergency medical services provided by local physicians. (See the sidebar for details on how to apply for reimbursement). This is a portion of a larger $2 million fund created by the Supervisors designated to support local financial losses incurred by physicians and hospitals due to the growing number of uninsured in San Bernardino County. This fund will also supply needed resources for tobacco cessation and prevention programs throughout the County.

In November 1998, the attorney generals of eight states (including California) and the nation's four major tobacco companies agreed to settle numerous pending lawsuits brought by states against the tobacco industry. The settlement agreement called for financial payments to the states, the creation of a national foundation to develop an antismoking advertising and education program, and the establishment of certain advertising restrictions to benefit public health.

On September 12, 2000, at the request of the San Bernardino County Medical Society, the Community Health Coalition of San Bernardino County, the Healthcare Association of Southern California, and many other community organizations, the Board of Supervisors approved the establishment of an Ad Hoc Advisory Committee to advise the Board on how best to spend a $2 million portion of San Bernardino's $16-18 million annual Tobacco Settlement. The committee heard testimony from dozens of individuals and organizations that told a devastating story of financial collapse of the local health care industry and the growing concern over tobacco prevention/cessation under funding in our local school systems.

In the mist of the worsening recession and rising health care costs, the number of uninsured California's under the age of 65 has risen above five million. 60% work full or part time or are self-employed. 48% are Latino, 28% are African-American, and 17% are Non-Latino Whites. In spite of California's Health Families Program, millions of California children continue to not have access to even basic preventive health care services.

Local hospitals testified before the Ad Hoc Committee that due to the growing number of uninsured that come to their emergency rooms and are admitted to their hospitals, the hospitals in San Bernardino County were providing over $22 million in charity care, indigent care shortfalls, and bad-debt costs. This has lead many hospitals to exhaust their non-profit foundations or simply consider closing their doors. Many physicians in San Bernardino are simply unable to cover the costs of running their practice. With the bankruptsy of KPC Medical Management leaving over 250,000 patients without a physician, it is clear that uncompensated health care costs by providers is putting the entire health care system at risk of collapse.

Tobacco use reduction advocates told a similar disturbing story of the under funding of tobacco cessation and prevention programs throughout our county. An estimated 1,941 deaths were attributed to tobacco smoking in San Bernardino County in 1998. The estimated costs of hospitalization due to smoking in San Bernardino in 1999 was $90 million, $600,000 paid from county indigent health care programs. According to the California Department of Health Services, for every dollar invested in tobacco prevention/cessation programs we save $3.62 in direct medical costs. In spite of the over $4.3 million spent by our county on tobacco control and prevention programs, most programs are under funded by 50-90% based on CDC recommendations.

On May 8, 2001, the Board of Supervisors approved the recommendations of the Tobacco Settlement Ad Hoc Committee to provide $250,000 for physician uncompensated care, $750,000 for non-public hospital uncompensated care, and $1 million for tobacco reduction programs throughout San Bernardino County. The entire San Bernardino County Board of Supervisors should be commended for bringing health care organizations together and building a partnership for solving our collective problems to provide medical care to our communities. Though the amount of money falls short of solving any of our current financial problems, the working together of the County Board of Supervisors and the health care community ushers in a new era of collaboration to meet our future challenges.

(Dr. Kenneth Lane is a former president of the SBCMS, co-founder of the Community Health Coalition of San Bernardino County, and a member of the Tobacco Settlement Ad Hoc Committee)

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