Cost-saving measures at city hospitals have made it harder for millions of poor and uninsured New Yorkers to obtain basic health care, according a new report from the nonprofit Commission on the Public’s Health System.
Giuliani administration cuts have stripped many Health and Hospitals Corporation (HHC) facilities of preventive clinics, forcing patients to run from hospital to hospital for care, charges the report, which studied 21 city heath care facilities. “If you need an X-ray, rehab and primary care for one problem, you may go to three different places,” says Linda Ostreicher, who authored the study. Ostreicher has spent much of the last year collecting documents from HHC and local hospital advisory boards in order to develop what she calls “a snapshot of a system in trouble.”
Since 1995, the city has laid off 10,000 HHC employees and slashed its annual budget from $350 million to about $55 million. In addition, HHC has closed or consolidated many specialized clinics and units at hospitals in Queens and the Bronx. An additional 600 job eliminations are slated for Harlem Hospital this year.
HHC officials say the layoffs stem from a recent decline in patients and HHC’s continued shift to managed care. “The workforce reduction is simply the result of a 24 percent decline in inpatient utilization,” says HHC spokesperson Jane Zimmerman. About 85 percent of the jobs cut do not directly impact patient care, she adds.
The report highlights disturbing examples of long waiting lists. There are 2,500 patients currently cooling their heels on an 18-month waiting list for dental care at Morrisania Hospital in the South Bronx. At Bellevue, 30 of the 57 clinics reported shortened waiting lists, but patients still wait up to 10 weeks for appointments at the hospital’s gynecology, arthritis and spine clinics.
There has been a 13 percent decline overall in emergency room visits since 1995. Yet because of chronically long waiting lists at HHC’s walk-in clinics, many of the city’s estimated 1.9 million uninsured patients still flock to ERs, according to Ostreicher. “They can wait until they are very sick and go to the emergency room at hospitals or go to a [non-HHC] community center,” she says, explaining that these options do not make up for the primary care that HHC used to provide.
Other findings include:
- Kings County Hospital doesn’t offer night hours at its psychiatric clinics, due to staff cutbacks.
- The emergency room at Jacobi Hospital in the Bronx is chronically understaffed during its busiest evening and weekend hours.
- Visits to the Belvis and Morrisania walk-in clinics dropped by a quarter in 1997–possibly due to a 20 percent staff cutback.