On Friday, Gov. Arnold Schwarzenegger vetoed measure AB 8 , a bill aiming to correct many of the ills of the state’s medical system with focus on hospital transparency.
The bill had been on the floor of the legislature for several months before Schwarzenegger defeated it and submitted his own bill emphasizing a plan to implement state-wide health insurance.
AB 8, while designed to cover a smaller portion of the state’s uninsured population than Schwarzenegger’s bill, would have provided more comprehensive coverage for the Californians it affects.
According to the Los Angeles Times, AB 8 contained conditions that would have fostered public review of hospital performance. Schwarzenegger’s proposal, the Health Care Security and Cost Reduction Act, includes many of the sections from AB 8 but is fundamentally different in its omission of clauses mandating transparency in the medical system.
“Hospital transparency is just a small part of the bill that the governor has been working on,” said Sabrina Lockhart, deputy press secretary for the Office of the Governor.
While the bill is still in the early stages of development, Lockhart stressed the governor’s commitment to improving quality, transparency and accountability in the state’s health care system.
In the past two years, the governor has only signed one bill for health care reform. SB 739, which requires hospitals to inform the state as to how carefully sterility measures are followed in California facilities, had been allotted some $1.3 million in funding; these funds were cut in August by Schwarzenegger in order to balance the budget.
Dr. Tom Rosenthal, chief medical officer at the UCLA Medical Center, said that the costs of reporting medical care statistics can be extremely high when considered on a national scale.
“We collect all kinds of information on our quality outcome,” he said, listing infection rates, catheter-associated sepsis and rates of hand washing among the statistics monitored at the medical center. Rosenthal added that the process of monitoring such statistics is tedious and labor-intensive, often requiring careful observation by highly trained individuals.
Lockhart explained that legislation on this issue is sensitive and that if hospitals are to be required to comply with these kinds of publication requests, expectations must remain realistic.
“Information must be disclosed in a way that wouldn’t create an environment in which an individual could file a frivolous lawsuit,” Lockhart said.
But, when asked whether or not the public is equipped with knowledge sufficient to properly interpret data like these, Rosenthal said he disagreed.
“I think that is possibly true,” he said, “but I don’t think it’s a useful reason not to make valid and meaningful data available to the public.”
According the Los Angeles Times, the hospital association, whose executives have expressed concerns with the publication of these data, contributed $44,600 to Schwarzenegger’s re-election campaign.
“(The governor) has worked closely with the hospital association for their contributions to this plan,” Lockhart said.
Mark A. Peterson, a professor of public policy at the UCLA School of Public Affairs, explained that there are many dimensions to be considered when analyzing the relationships between elected officials and public interest groups like the hospital association.
He said hospital statistics like those discussed in the proposals before the state legislature need to be considered in the appropriate context.
If statistics like these are to be used as a performance measure for hospitals, consideration must be given to the fact that a hospital’s patient mix is a contributing factor to its statistics, Peterson said, pointing out that “you could end up punishing hospitals that actually take on the most challenging and most problematic patients.”
He went on to assert that the hospital association’s involvement in the formation of legislative plans should be scrutinized.
“In a world in which there are enormous stakes, tremendous complexities and a long history of policy failure, one needs to be very astute about how one assembles a coalition,” Peterson said. “Each member of that coalition can be instrumental.”