Chopping Block: Public Health

by Andrew Thompson

As the city tries to cut another billion dollars out of its 5-year budget, City Paper is taking a look at how cuts and proposed cuts are affecting different services and functions — not to argue against any individual cut, necessarily, but to catalog the damage. This week's focus is public health.

As part of a broader strategy to shore up the city's budget holes, the Philadelphia Department of Public Health is looking at instituting fees for visits to the city's now-free public health centers and — if things look really bad — closing one of the eight city-owned health centers entirely.

In a telephone interview, city Deputy Mayor of Health Donald Schwarz pledged not to charge fees to people living under the federal poverty line, and said the fees would be implemented on a sliding scale.

"We should have [already] been charging fees," he says. According to budget drafts that were leaked last week, the city expects to net around $766,000 from the change. Schwarz thinks the city could have been collecting that money for years, without compromising care.

While the exact rates remain undetermined, the city will have to balance filling its widening financial chasm with fulfilling the goal of the health centers: Providing affordable care to prevent patients' health from deteriorating (thereby saving the city more in the long run). That's why the department is loathe to shut down a health center. Even though closing one could save a quick $2.35 million, it would add time and travelling costs for patients. Throw in the fact that health centers are already notoriously congested, and the additional waiting time could dissuade some people from getting health care at all.

There's no telling how much those untreated patients would cost the city in the long run, but the threat is bad enough for the Health Department to want to reserve closure as a nuclear option only.

Closing Philadelphia Nursing Home was also briefly considered, but quickly taken off the table, says Schwarz. Because of the characteristics of many of the home's patients — unable to care for themselves but under 60, and therefore too young to qualify for Medicare — "the types of options for people like that in other nursing homes are practically nil," he says.