SAN DIEGO — As Los Angeles County officials struggle to rescue their bloated, bureaucratic and financially desperate public health system, they might want to look southward.

For a generation, San Diego County has made the sorts of cost-conscious moves that Los Angeles County is only now reluctantly considering in response to a crisis brought on by deep cuts in public funding.

Unlike their counterparts in Los Angeles, San Diego County officials have opted for a health care system that keeps the number of public employees to a minimum and instead stresses reliance on private sector and nonprofit groups. San Diego also insists on strict eligibility criteria for medical care and has curtailed services to illegal immigrants.

The San Diego County Department of Health Services does not operate a single hospital. Since 1966 it has had a contract with UC San Diego Medical Center to provide indigent care and emergency services. The backbone of the San Diego system is not a huge public hospital but a network of community clinics. The clinics are run not by the county government, but by nonprofit organizations that are seen as more efficient and economical.

Under the San Diego system, not all medical services are offered and not everyone is covered.

On the other hand, the San Diego system is not teetering on the edge of bankruptcy nor locked in political uproar and labor-management strife.

Joel Kotkin, public policy fellow with Pepperdine University and a senior fellow with the Pacific Research Institute, cites San Diego as the polar opposite of the big government, big bureaucracy approach to public health care used in Los Angeles and New York.

"As Los Angeles and New York begin to look at ways to fix their gaping budget shortfalls, the San Diego model possesses enormous appeal," Kotkin wrote recently.

"We are the future," said Roberta Feinberg, executive director of community clinics in the racially diverse Linda Vista section of San Diego.

Doing more with less. Working cooperatively rather than competitively. It is a mantra heard in health departments nationwide, particularly when discussion turns to public hospitals.

Once, public hospitals were the crown in the nation's public health system. Now, they are often seen as millstones.

In New York, the city's municipal hospital system--the largest in the nation and for decades the model for the rest of the country--is beset by a flood of uninsured patients, suffering from competition with private institutions and lacking strong leadership.