An admittedly “very preliminary” plan on consolidating the number of local health departments and districts into larger regional agencies is getting extensive push back from the state’s largest lobbying group for town and city governments.
State Department of Public Health Commissioner Dr. Raul Pino recently met with local public health directors about the proposal that would merge the state’s 70 health departments, which include single-town departments and multi-town agencies, into as few as eight large districts.
“We will be continuing to meet with local health directors, municipal elected officials, and other stakeholders to hear and address their concerns and to explain this proposal,” said Maura Downes, spokesman for the Health Department.
The consolidation, Downes added would improve “the quality and continuity of health services and address health disparities in Connecticut.”
Each municipality would pay 1.5 percent to 0.5 percent of its annual operating budget to the regional district.
But leaders of the Connecticut Conference of Municipalities, which represents 162 towns and cities in the state, so far aren’t on board with the plan.
In a letter to Pino, CCM officials said: “Public policy should be developed by convening all stakeholders to be part of the process, from inception to completion. Proposed policy changes that make significant changes to the current landscape without all parties involved unnecessarily creates an adversarial environment which is not conducive to sound, workable laws.”
Downes said there are several other states in the country that are at “different stages” in converting to larger, consolidated health departments, including Ohio, Massachusetts, Kentucky, West Virginia and Wisconsin.
She referred to a 2014 study on Connecticut health districts that found that “the structure, governance, resources and functions of health departments/districts in Connecticut are inconsistent and do not equitably serve all residents.”
That same study found that Connecticut’s local public health system was the second-most fragmented in the country for its land size and per government entity and the ninth-month fragmented by population.
Downes said studies show that larger health districts serving at least 100,000 people show that the costs per patient are lower per capita than at smaller health districts.
Additionally, the Connecticut Health Department research shows that consolidated health departments are more successful at securing federal funding than smaller health departments.
Downes said that the Health Department has submitted the proposal to Gov. Dannel P. Malloy’s office and the Office of Policy and Management “for their review and look forward to receiving their feedback.”
The proposal is likely to undergo several revisions before any legislation for the 2017 session is announced, Downes said. Health officials add that when and if legislative action is taken to consolidate health districts it would take until 2020 to enact the change.
Under the current version of the plan, the health districts would be reorganized along the boundaries of the state’s eight counties, or along the boundaries of the regional councils of governments.
Under an alternate plan, the districts would follow county boundaries, but the state’s five largest cities — Hartford, Bridgeport, Waterbury, New Haven and Stamford — would each maintain their own health departments.
In its letter to Commissioner Pino, CCM Executive Director Joseph DeLong, Somers First Selectman Lisa Pellegrini, who is also chair of the CCM Policy Committee on Public Health, and Barkhamsted First Selectman Don Stein, vice chair of the same committee, pull no punches.
“While CCM appreciates the concept of sound consolidation to achieve efficiencies and improve effectiveness, the proposal (a) is overly burdensome, (b) imposes a costly unfunded state mandate, (c) doesn’t address the necessary collective bargaining issues, and (c) adds another layer to the state’s existing regional entities morass,” said the CCM officials in their letter to Pino.
The letter to Pino goes on: “CCM has long advocated for local officials to be afforded the discretion to determine which delivery model works best for their communities – either operated locally or regionally – as they do now. The draft proposal does not afford local officials that discretion.
“By mandating that municipalities allocate 1.5 percent of their budgets to health districts, the proposal will increase the costs associated with public health services by a factor of 5-10 times, without properly identifying any overarching problems with the current system,” the CCM letter said.
“The proposal would require cuts in other important local services or employee layoffs. The proposal does not address the issue of reducing health disparities as intended, but in fact will have the consequence of increasing inequity by burdening already stressed cities and towns.”
The CCM officials are asking the Health Department to “establish a legislative task force comprised of DPH, local chief elected officials and public health directors, from a range of populations and demographics, to examine the issue of local public health delivery and possible consolidation.”