Last week, I wrote about the need to increase funding for city district health centers. A new report from City Controller Alan Butkovitz provides more evidence that supports this conclusion. The study, which was conducted by a private company called Practical Healthcare Solutions, examined two areas: the long wait for appointments and how city pharmacies operate. The report found problems with both.
We already knew that it takes a long time to get an appointment at city health centers. The Philadelphia Unemployment Project released a study a year ago that found it can take between 3 and 5 months to see a doctor. Butkovitz's report says that the average wait is actually 165 days. That's about 5 and a half months-- suggesting the problem may be even worse than PUP originally thought. As you can see from the graph posted on the front page, Butkovitz also compared the wait in Philadelphia to other cities and found that we don't measure up very well.
The report also looked at how pharmacies operate and a found a number of areas that need improvement. This is a subject that I touched upon in my op-ed but didn't really examine in-depth. According to the study, city pharmacists have to fill between 300 and 365 prescriptions every day. The sheer volume means that staff have less time and energy to conduct the necessary safety controls that make sure patients receive the right kind of medication. Beyond the safety issue, there are also basic problems with customer service. City pharmacies can take up to two days to fill a prescription and patients can only pick up their medicine during regular work hours.
The solution to these problems in city pharmacies? Spend more money. The report suggests that the city should immediately hire four pharmacists and assign them to the busiest health centers. Butkovitz also says that the city should increase the salary of pharmacists and other pharmacy staff to attract qualified employees. The report also says that the city needs to hire more doctors, apply for more funding through grants, and look at potentially building as many as three new health centers around the city.
Comments (2)
It might also be appropriate to contract out for medical professionals. This is used by other providers. For example, hire temporary pharmacists, locum tenens docs, and have per diem nurses, pharm techs, etc.
This is one way to avoid the costs of full benefit hires while staffing adequately. It also gives the health centers time to see who is a good fit in their mission, and who might think they are, but want to move on.
This is standard practice in for all health care providers. The city's aversion to contracting out for workers causes bureaucracy to become rapidly bloated and unresponsive, with high turnover that prevents institutional knowledge from being handed down.
City Health Centers can't afford to eschew contracted employees, even it it means using a private contractor arrangement.
Posted by Anonymous | April 10, 2008 4:30 PM
Why not publish the City Health Department budget? With so many health care admin people in the city, there are any number of people who would freely contribute, even volunteer, advocate, and do what it takes to share their experience on managing unwieldy health care institutions.
There could just be an abbreviated form of the budget, or a more indepth spread sheet that you could scroll around. Obviously, there are going to have to be cuts to find funds, so why not make those cuts as intelligently as possible?
I get the impression that the city doesn't want to let people in on its little fiefdoms. Thing is, as Nutter said, openness and transparency pays huge dividends every time.
Posted by Anonymous | April 10, 2008 4:45 PM