Grand jury: San Mateo county needs answers

When it comes to funding indigent health care, San Mateo County must find a solution that balances the needs of its poor with the realities of its budget, according to a grand jury report released Tuesday.

Providing care to the indigent amid rising medical costs and fewer people who can afford insurance is a national problem, and the grand jury found San Mateo County was no exception, said foreman Stephan Freer.

San Mateo County provides about 95 percent of its care to the indigent through the San Mateo Medical Center, Freer said. Contributions from the county’s general fund for indigent and charity care have grown from $42 million in fiscal year 2001-02 to a budgeted $70 million in fiscal year 2006-07, the grand jury found.

However, the county budget itself has grown about 39 percent and the percentage of the general fund going to the medical center has remained roughly constant during the five-year period — and if the medical center’s needs outpace the county’s revenue or the county decides to increase its support for the indigent, other programs will have to be cut, Freer said.

The grand jury also found that the county is sending mixed messages when dealing with its obligation to provide indigent care. While the county manager is insisting the increasing flow of money to the San Mateo Medical Center must be stemmed, the Board of Supervisors has commissioned a blue ribbon task force to explore extending health care access beyond the indigent, to the uninsured working poor.

Supervisor Rich Gordon said he agreed with much of the grand jury’s report, but said he took issue with the assessment that the supervisors’ goals were at odds with the county manager’s recommendations. The blue ribbon task force, he said, is tasked not only with exploring the costs of expanding the level of coverage, but reconciling those costs with the hard realities of the county’s budget.

The grand jury also addressed the recent proposals for containing indigent health care costs at the San Mateo Medical Center, including increasing revenue and reducing costs at the hospital; closing it or leasing it to a private operator; reorganizing the county’s health care districts; and retaining the hospital but changing its mix of service.

The grand jury found that leaving the San Mateo Medical Center open but changing its mix of services appears to be the only proposal likely to result in significant cost reductions.

Who are San Mateo County’s uninsured?

» Adults 19 to 64 without insurance: 12 to 13 percent, or up to 60,000 people

» Uninsured adults working full-time: 47 percent

» Uninsured adults working in some capacity: 63 percent

» Uninsured adults who are noncitizens: 55 percent

» Uninsured adults with children in the household: 51 percent

Uninsured adults are 51 percent female — the same gender distribution as San Mateo County in general. There are disproportionately more Hispanic/Latino and Asian/Pacific Islander adults who are uninsured.

– Source: December 2006 “Report to the Task Force: Demographic Highlights of the San Mateo County Uninsured Adult Population” and April 2007 LAFCO Reports.

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