How should health care be provided to the poor of Cook County? The debate is an old one, and it’s being heard again in current arguments over the future of Cook County Hospital.
A bit of historical perspective may be in order. The Illinois “poor laws” of 1833 established the county as the political unit responsible for assisting the state’s poor and indigent. After all possible family resources were exhausted, a “pauper” was eligible to “receive such relief as his or her case may require, out of the county treasury.”
Actually, it’s cited by all sides of the argument. The original issue–who’s responsible for the delivery of free health care–isn’t debated much anymore. Most people acknowledge that the county is. Now it’s the scope of that care that’s in question. Representatives of the county feel that Cook County Hospital largely fulfills the county’s legal obligations. Critics like Dr. Quentin Young are adamant that the county has the ethical–and possibly legal–responsibility to do much more.
These trips are HMPRG’s latest effort to refine and promote its ideas about the future of health care delivery in Cook County. Dr. Young, Professor J. Warren Salmon of the University of Illinois, and their colleagues at HMPRG already have developed a master plan, “Toward a Cook County Public Health Delivery System: A New Vision,” that calls for an expanded county system including a network of approximately 30 county-owned, community-based primary care clinics. The clinics would feed into two or three “mega-clinics.”
Most projections suggest that the health care needs of the poor and indigent will rise as the population ages, AIDS takes a greater toll, and economic conditions worsen among our poorest citizens. We see now the widely reported phenomenon of “dumping,” private hospitals refusing to treat uninsured patients and sending them instead to Cook County Hospital, sometimes in medically unstable condition.
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Meanwhile, the hospital continues to deteriorate. Accreditation by the joint Commission on Accreditation of Healthcare Organizations, an important measure of a hospital’s quality and ability to attract top people, is in constant jeopardy, largely because of physical plant shortcomings. The popular perception of County is also a problem: the hospital is habitually portrayed as a crumbling, chaotic place where patients wait for hours in antiquated wooden wheelchairs before they can be seen.
“So number one, I don’t believe in the use of the word ‘dumping’ for economic reasons. That policy is in effect; that’s why the state established us. Number two is the issue of stability; there are certain clinical services that feel that if you’re stable you can be transferred, and there are other clinical services that feel if you’re unstable, and you’re an indigent patient, then maybe you are better off coming to a tertiary-care [full service] hospital right away, and quit horsing around; get you here quickly. So they’re willing to accept you [at County] in an unstable condition.
