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National Association of Counties • Washington, D.C.      Vol. 34, No. 18 • September 30, 2002


John H. Stroger, Jr. Hospital of Cook County prepares to open
By M. Mindy Moretti
Associate Staff Writer

When John Stroger, Jr. was first elected to the Cook County Commission, healthcare wasn’t really on his agenda. But when he was assigned to the health and hospital committee and saw the toll of what caring for all members of the community was taking, Stroger had a vision.

After years of hard work, and a bit of political luck, that vision is about to become reality in the form of one of the newest public hospitals to open in the country in many years.

The modern John H. Stroger, Jr. Hospital of Cook County replaces the original Cook County Hospital, built in 1912 and the oldest public hospital in the country. While the original county hospital is known throughout the world for its excellence in teaching and has provided care for millions of people throughout the years, time has taken a toll on the building and its facilities.

“I have spent probably the better part of 30 years doing renovation work on the old Cook County Hospital,” Gary Mundinger, a lead architect with the Cook County Hospital Design Group, told Midwest Construction Magazine. “When they move into the new building, it will be like they have jumped an entire century. It will be like they are going from the 19th to the 21st century.”

The new hospital is designed to reflect the trend in managed care to fewer, shorter hospital stays and more outpatient services. The old hospital was built shortly after the invention of air conditioning and with a ward system that could accommodate up to 3,000 patients, although it is currently staffed for about 500 beds. The new hospital will have an up-to-date ventilation system and 464 beds in private and semi-private rooms.

The design of the new hospital groups related functions and centralizes core services. The hospital also has an eye to the future with a flexible floor plan and a wiring infrastructure that will accommodate future technologies.

According to a spokesperson for the American Hospital Association, many hospitals throughout the country have reached a point where they must undergo major renovations or build new structures. Unfortunately, finances often prevent these renovations so Cook’s new hospital is considered a major success.

It took a while to get the backing, but Stroger, president of Cook County’s Board of Commissioners and past NACo president, never doubted it would happen.

“I always thought we could get it done if we had the political will,” Stroger said. “But there were many people around here who didn’t agree with me.”

But once he won approval, and most importantly, the financial backing, Stroger set to work on getting the new hospital off the ground. Work began in 1998 and the first patients are expected to arrive sometime in October.

It is estimated that the hospital, which cost $551 million to build, will save taxpayers $670 million in the first five years of operation.

According to Stroger, he’s honored to have his name on the new hospital, but after pursuing this project for years, he’s more pleased with what the hospital offers than what it’s called.

“I feel very honored that my colleagues on the County Board would honor me this way,” Stroger said. “But the greatest privilege is to know that we have a first- class facility — a twenty first century hospital that will serve the needs of the medically impoverished in our county.”

As for the old Cook County Hospital, the plan is to demolish the structure, but possibly save some of the façade. And if people in Cook County really start to miss the old place, they can always tune in to NBC-TV on Thursday nights for ER, set in the old Cook County facility.

County Health Facilities Face Uncertain Futures

As Cook County prepares to open its brand new facility, other county-run hospitals throughout the nation are facing diverse fates. Some county governments turned control of their hospitals to the private sector years ago, while others are struggling with that decision today. Some are preparing to undergo major renovations with earned revenues, and others are being forced to close down health centers for financial reasons.

According to a NACo survey, counties own or operate 392 hospitals and own, but contract out services, for 245. In FY97, county expenditures for those 637 hospitals were more than $19.5 billion.

In a recent study, the National Association of Public Hospitals and Health Systems (NAPH) found that half of its members experienced negative margins in 2000, compared to less than one-third five years ago. The NAPH study found that a variety of economic and social factors combined to increase the financial pressures on “safety-net” providers. Those factors include:

  • onset of the current economic downturn, which began to shrink state and local tax revenue
  • federal and state policy changes that reduced Medicaid and Medicare payments
  • shortages in many key health professions
  • double digit increases in the cost of drugs, pharmaceuticals and other essential supplies, and
  • renewed growth in the number of people without health insurance, creating more demand for services on public hospitals.

Faced with many of these issues, some counties are being forced to make tough decisions about their health care systems.

For instance, Tulare County in California got out of the hospital business years ago. The county still operates some health services and provides health education to its residents, but the county no longer runs its own hospital.

Other counties, such as Los Angeles, are currently dealing with difficult, and often extremely unpopular decisions to shut down or scale back clinics and hospitals.

Faced with a budget deficit that is expected to reach $800 million within three years, L.A. County was recently forced to make major cutbacks to its health system. The Board of Supervisors voted to shut down 11 health centers and four school-based health clinics by the beginning of October. L.A. County Health Services Director Dr. Thomas Garthwaite told The Los Angeles Times that the 11 health centers slated for closure are in need of critical maintenance and repairs totaling more than $20 million. Garthwaite told the Times that the centers are inefficient compared with clinics run by private health providers. The county was also recently forced to cut 25 percent of its $60 million public-private partnership program that subsidizes the county’s private clinics.

The county acknowledges these decisions have been difficult and unpopular with the public, but at a recent Board of Supervisors meeting, Supervisor Zev Yaroslavsky said the county had nowhere else to turn.

Despite the difficulties faced by some counties, others, like Lafayette County in Indiana, are actually experiencing positive revenue margins. The county is preparing to undertake a $2 million remodeling and upgrade project. The hospital plans to borrow some of the necessary funding, but if the hospital keeps at its current earnings pace, it could provide $700,000 toward the project.

Still, the positive stories, like those in Cook and Lafayette seem to be few and far between. Unfortunately, more and more public hospitals, particularly those run by already cash-strapped counties are facing the same difficult decisions faced by L.A. County.

“These findings are especially alarming, given the increasing importance of public hospitals to public safety, emergency preparedness and the potential of bioterrorism,” said Larry S. Gage, president of NAPH.  “We have no reason to believe that these financial pressures are going to abate any time soon.  On the contrary, they are quite likely to worsen.”