In recent years, a number of public academic medical centers (AMCs) have attempted to meet new marketplace challenges through conversion to private sector status. However, even without such overt moves, public AMC reorganization may place their commitment to traditional public health responsibilities into question. In July 2000, the Medical University of South Carolina, while remaining formally public, shifted governance of its Medical Center from state government to an "Authority". The Authority has greater management flexibility, since it is exempted from many state regulations concerning procurement, capital improvement and personnel. Assurances have been provided that the Medical Center will remain devoted to its public health mission. On the other hand, it has also been noted that "our state constitution does not require the state or counties to provide indigent care." The authors analyze Medical Center decisionmaking by the Authority during the last several months, including the first-time imposition of charges per visit on all uninsured outpatients; the coming end of services at the County Hospital, where many indigent patients received care; a continuing hiring moratorium, reducing already low Medical Center staffing; public statements discouraging state physicians from referring uninsured patients to the Medical Center; and initial consideration of a gradual geographic shift of the Medical Center from the central city to various suburban locations. The authors conclude by considering the tradeoffs being made because of budgetary pressures, and suggest that "conversion" from traditional public health missions can be brought about by reorganization without a formal shift to private ownership.
Learning Objectives: At the conclusion of this presentation, the participant should be able to: 1. Understand the impact of the shift to "authority" governance on various managerial functions 2. Identify the ways in which Authority governance has led to changes in Medical Center decisionmaking with respect to indigent patients 3. Note the potential impacts that these decisions may have on traditional public health services and health outcomes 4. Understand how these potential impacts might be measured during the coming years 5. Consider the extent to which public health values are threatened by reorganization efforts, whether or not they constitute formal "conversion"
Keywords: Health Care Restructuring, Vulnerable Populations
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.