Public Health – Transfer the Responsibilities of the Department of Public Health to the Cook County Health and Hospital System

Savings: $33.7 million

The Chicago Department of Public Health (CDPH) provides a variety of services including primary and mental healthcare services through neighborhood clinics and at-home services, runs Sexually Transmitted Disease (STD) and tuberculosis clinics, and is in charge of all health inspections of the City’s restaurants, grocery stores, and other food vendors.

Under this option, the CDPH would be eliminated and all Public Health activities would be transferred to the Cook County Health and Hospital System (CCHHS).   The City-funded portion of CDPH’s 2011 budget was $33.7 million.  Additionally, CDPH was projected to receive an additional $153.6 million in federal, state, and private grants.  Thus, eliminating CDPH and having CCHHS assume its duties would save the City $33.7 million annually.

Implementing this option in its entirety would require a change in State law, as the Illinois Municipal Code provides that “a municipality in a county having a population of 2,000,000 or more inhabitants must regulate and inspect retail food establishments in the municipality”.[1]

Proponents might argue that a single public health system for Cook County would result in a better use of resources and fewer administrative costs (i.e. one HR department, one grants management department, etc.).  Currently, CDPH and CCHHS both “provide STD and HIV/AIDS services, immunizations, and services for women, infants, and children”.[2] Additionally, if CCHHS ran all the area’s public health clinics there’s likely to be greater continuity of care for patients because it also runs the public hospitals.  Finally, the passage of the Affordable Care Act (ACA) at the federal level [National Health Insurance], should result in the decline in demand for some of the services provided by CDPH as more existing patients obtain health insurance.

 

Opponents might argue that with the County being in a poor financial position, the transfer of these responsibilities would likely result in a reduction of services.  Additionally, to reduce duplication of services, existing health clinics might be closed — adversely affecting certain communities. Finally, if the City terminated its public health activities, it would be without resources to confront natural disasters and other emergencies on its own.

Discussion and Additional Questions

A key consideration regarding whether to implement this option is comparing how well CDPH and CCHHS currently serve clients.  Another consideration is the specific areas in which the systems overlap both in terms of geography and of service. Some questions to consider:

  • For both systems’ primary health clinics, what are medical outcomes of clients served by the two systems? And for individual clinics?
  • What are the customer service ratings of the two systems’ primary health clinics?
  • What primary healthcare clinics from each system are within 1 mile of each other indicating a possible duplication of services?
  • Do both the CCHHS and CDPH provide overlapping in-home healthcare services?
  • What areas of the City are not covered by either system’s primary healthcare clinics?
  • For public health services such as mammography that both systems provide, what are each system’s approaches to delivering the service?
    • What populations do they aim to serve?
    • What technology to they use?

If CCHHS were to absorb the responsibilities of CPDH it would receive a substantial amount of additional federal, state, and private funding.  A key question is:

  • With this additional funding and efficiencies achieved by merging the two systems, would CCHHS be able to deliver the same amount of services without relying on additional County resources?

Budget Details

Dept: Public Health, 041 Bureau:  NA
Fund: Corporate Fund, 0100 Approp Code: Various
The appropriation is located on pg. 115 of the 2011 Annual Appropriation Ordinance.

http://www.cityofchicago.org/content/dam/city/depts/obm/supp_info/2011BudgetOrdinance.pdf


[1] Illinois Complied Statutes. Illinois Municipal Code Chapter 65. Sec. 11‑20‑16. Retail food establishments. http://www.ilga.gov/legislation/ilcs/ilcs4.asp?DocName=006500050HArt.+11+Div.+20&ActID=802&ChapterID=14&SeqStart=156700000&SeqEnd=158600000

[2] City of Chicago and Cook County. “Joint Committee on City-County Collaboration”. June 2011. pg. 50.

http://www.cityofchicago.org/content/dam/city/depts/mayor/Press%20Room/Press%20Releases/2011/June/CityCountyCollaborationJune2011.pdf