The predictions are grim: crowded emergency rooms, well-baby clinics closed, more laid-off workers with no health insurance and many elderly people without a doctor because this could be the year their family physician quits Medicare.
As the national recession continues, Orange County health experts are painting an increasingly dark picture for 1992, particularly in publicly funded health care.
The county's AIDS toll--1,785 men, women and children through November--is expected to climb.
But for all the pessimism, a few health projects are expected to start or even expand in the new year.
- Health leaders expect tough new building codes and a new countywide ordinance that could help prevent child drownings in 1992. Local officials may require fencing on all four sides of a pool, plus alarms and self-latching gates--several barriers between child and pool. About 65 children drowned or nearly drowned in 1991, but a countywide ordinance that could lower the death toll is six months away, according to Tom Uram, Orange County Health Care Agency Director. The ordinance would affect new construction, not existing pools, he said.
- An innovative birthing center, tended by nurse midwives and aimed at women with low-risk pregnancies, is expected to help ease countywide crowding on Medi-Cal maternity wards. UCI's nine-bed center in Anaheim, which opened early this month, will handle 1,500 deliveries in its first year, providing good but low-cost care. A second birthing center is to open by fall at Western Medical Center-Anaheim.
- County officials are hoping a detailed plan to provide basic medical care for indigent patients might be carried out by late 1992. Currently, uninsured patients flood overtaxed emergency rooms for treatment of bronchitis and other ailments which could be handled less expensively in a doctor's office.
But, until that plan takes effect, health leaders such as Faith Hagerty, executive director of the Coalition of Community Clinics, predict more crowded emergency rooms and "more people, newly laid off, going without primary and preventive care."
With local health funds pegged for the first time to sales tax and vehicle license fees, county health leaders say the $80 million they expected from these now-declining state funds could be short by $8 million.
Trying to salvage already-lean medical and mental health medical programs, Health Care Agency Director Tom Uram has imposed a freeze on hiring and halted small equipment purchases.
But if the shortfall continues, Uram fears major cuts by February in well-baby clinics, immunization clinics, an interpreter program for Asian patients and perhaps other services as well.
"It's terrible," Uram said. "But if revenues don't go up, we'll have to run less of a program."
Asked if he saw much hope of saving these programs, Uram said no.
"I don't think we're fighting to save things," he said somberly. "I'm thinking which program to cut. There's no magic left (to save programs)."
But leaders of United Way's 50-agency Health Care Task Force are already vowing to fight any health care cuts. "We need to shift more money into prevention--immunizations, child health, prenatal care," said task force chair Mary Evelyn Bryden. "We'll oppose those cuts just as we did last year."
Also in 1992, Bryden's committee plans a detailed review of the health care agency, looking for "inefficiencies" and suggesting which public services could be better run by private firms.
Another problem for 1992: Some physicians, disgusted by decreased reimbursements, may stop treating Medicare patients.
"I had a patient come in yesterday morning who was seen by this other doctor for a number of years. And he just decided not to take Medicare patients. Ever," said Dr. Lawrence Kammerman, president of the Orange County Medical Assn., who considers the trend unfortunate.
"I have not heard any numbers, but some doctors say they will drop out," Kammerman said. The reason is low reimbursement rates--about $28 for an office visit, as much as a 45% reduction from last year for some types of surgeons, Kammerman said.
And if some doctors won't see Medicare patients in the office, the problem could become worse when seniors need to be hospitalized.
"It could become more difficult to find physicians to cover the Medicare patient who comes in through the emergency room," said Russ Inglish, vice president of the Hospital Council of Southern California. "I've heard said that it is as difficult to find a physician for a Medicare patient as for a Medi-Cal patient," a reference to the state's often-low-paying health insurance plan for the poor.