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What are
County Health Authorities?
In Oregon, public health, mental health and veterans
services are "delegated" to counties under state law. As
compared with welfare and child protective services
which are not delegated and are operated by state
agencies. This means that counties are accountable to
the state for certain "delegated" mandates, such as, 24
hour crisis services, services to people at risk of
psychiatric hospitalization regardless of ability to
pay, vital records, communicable diseases, and more.
Most of the contracts between state and county package
all of the services together under one big contract
(e.g.: Mental Health Division's Omnibus Contract and the
Oregon Health Division's contract with county public
health departments.) When delegating the "authority,"
the state's intent is for the county to assure that the
mandated services are provided according to state
administrative rules.
Counties have choices; embedded in state law, which
stipulate the state to county, government to government,
relations. Counties can manage these contracts and
implement the mandates themselves, such as when CHD was
a part of county government. We served as both the
county's "community mental health program" and "public
health authority" and implemented direct services. Or,
they can choose to contract out.
If counties choose to contract, they have the local
control to engage in contracts for certain direct
services or they can contract the entire public health
authority or community mental health program. In our
case, Union County Commissioners chose to contract with
CHD for both the "authority" and the services.
Does CHD
have a Conflict of Interest?
At the local level, CHD and the Union County
Commissioners need to be attentive to the risks of
conflict of interest inherent in their model. This
refers to the situation where the authority (overseeing
assurances) and the provider of service, are the same.
This was taken into consideration by the county
commissioners when they privatized CHD. The county made
a deliberate choice not to hire more government
bureaucrats (on the tax payers bill) to monitor CHD.
Rather, they understood that the state conducted annual
and bi-annual reviews; managed care companies conducted
quality assurance reviews; and locally, the Union County
Health & Human Services Advisory Committee also provide
input to the Union County Commissioners. Between all of
these various regulatory oversights, it was not
necessary to create yet another government oversight.
This has been thought of as quite progressive and very
consistent with the principles and emergent trends in
"reinventing government." CHD has proven through
consultation with the county commissioners and the
Health & Human Services Advisory Committee, that we are
acutely aware and conscientious in managing the balance
of this potential and built-in conflict of interest. If
we do not, we would be negligent in our role as the
county's public health authority and community mental
health program.
We feel strongly, that we have an obligation, which is
deeply rooted in our public sector experiences and
values, to fulfill the mandates set forth in the state's
contract with the county and the county's contract with
CHD. At times this may mean making tough decisions
related to the variety and quality of health care in our
community. Our role is to protect and balance the
county's interests in working for a healthy community.
CHD &
Union County Contract Today
Our contract with the county rolls-over automatically
every two years, no bidding is required. Unless, 60 days
prior to the end of a contract period, the county
commissioners choose to give notice to CHD and open-up
the process of selecting a contractor or multiple
contractors. Many of our private sector competitors have
wanted the county to do just that: open it up for bid.
Historically, the commissioners have not wanted the
contract to be "cherry-picked." In other words, the more
lucrative services going to providers, leaving services
which don't pay for themselves, high and dry. Services
and activities which rarely pay for themselves include:
un-and under-funded mandates that county authorities
must perform by state law; services for the most
vulnerable populations, such as people with major mental
illnesses; or prevention and health education not
covered by any health insurance.
The commissioners have preferred to keep the contract
intact-under one roof. This is more cost-efficient for
them and they can implement it without adding more staff
for monitoring various contracts. For the citizens of
our community, it allows funds that are generated for
treating illnesses to be reinvested in our community's
health.
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