Looming Budget Cuts Put Chicago’s Public Health System at Risk

Oct. 20, 2008 – As aldermen received Mayor Richard M. Daley's proposed 2009 budget last Wednesday, the Chicago Board of Health prepared for the worst.

At its regular meeting a few blocks from City Hall, the board announced a projected $12 million cut to its 2009 budget — including $6 million allocated by City Council to provide public services — which members say is only the beginning of what will be a long-term decline in health funds.

"Some things have to get worse before they get better," said Board of Health President James R. Webster. "Now they are worse."

The Board of Health, which had a budget of about $204 million in 2008, spent about $19 million operating seven public health clinics overseen by Chicago Neighborhood Health Centers, a government agency that operates clinics in some of Chicago's poorest neighborhoods such as Englewood, Roseland and South Lawndale.

Those clinics, already struggling to stay open, are certain to face major challenges as their operating budgets plunge, said Richard Sewell, chairman of the Neighborhood Health Centers board.

Health Commissioner Terry Mason said clinics are already experiencing major revenue losses, down $2 million from last year, due to a radical decline in patient visits over the last six years — from almost 90,000 in 2002 to less than 30,000 in 2008.

Mason said patient decline might also be due to an increase in Chicago of Federally Qualified Health Clinics, which enjoy larger staffs and greater managerial efficiency. These clinics, he said, have aggressively targeted patients that produce high revenue, such as pregnant women and children, driving returns away from city clinics.

Earlier this year, municipal clinics implemented new technology services to enhance their administrative efficiency, which has slowed down the clinics' ability to schedule, process and bill clients because the staff has not yet been adequately trained to use the new infrastructure, Mason said.

Carolyn C. Lopez, a Health Centers board member, said the move is "a good thing, but difficult and slow to implement even in the best situation." But, she said, in the long run it will have a significantly positive impact on clinic efficiency.

Perhaps the biggest blow to Chicago Neighborhood Health Centers, though, was a promise under Daley's budget to cut as much as 36 percent of clinic employees.

Lopez said staffing has posed a major challenge to health clinics in recent years, where long wait lists for appointments and even longer lines to see physicians have deterred some sick patients from getting treatment, driving potential revenue out of the system.

Lopez said further budget cuts may force the shutdown of two more clinics, which means many patients will have to travel further and wait even longer to see a doctor, further reducing returns that could otherwise be reinvested in the health system.

In light of these expected cuts, the board renewed its commitment to provide health care to those in need.

"It's gonna take some serious, willing-to-die leadership," said Carl C. Bell, a member of the Board of Health. Bell urged his colleagues to keep public health a priority despite economic decline, arguing that public health has historically taken a backseat to politics and patronage.

The 2009 proposed budget still must be approved by city council in order to take effect, which could happen as soon as Nov. 5. In the interim, the Board of Health said it is urging aldermen of wards that are home to health clinics or a high number of clinic patients to reject the cuts and save Chicago's public health system.