DPH Considers Regionalization, Local Leaders Have Big Concerns
Manchester Journal-Inquirer, October 10, 2016
Potential legislation intended to consolidate and regionalize health departments across the state could have a significant impact on spending and services in north-central Connecticut.
According to Jeffrey Catlett, director of health for the Manchester Health Department, the potential shift proposed by the state Department of Public Health has three possible outcomes, all of which would lead to a significant reallocation of resources.
While Connecticut currently has 73 health departments between towns and municipal efforts that group several communities, Catlett said, the most likely outcome would group departments based on counties or councils of governments.
That means the 73 current departments would be regrouped into just eight or nine, a drastic reduction.
Should the legislation move forward, each town would have one member on a county board of health, public health Commissioner Dr. Raul Pino would have control over hiring directors of health, and all health department jobs would be part of the county instead of the town, Catlett said.
Maura Downes, DPH spokeswoman, confirmed that early discussions have occurred between Pino and local health directors, though any changes are in a “very preliminary stage.”
“Nothing has been proposed as of yet,” Downes said. “As we prepare for the 2017 legislative session, DPH is exploring many different options for legislative proposals that would improve the quality and continuity of health services and continue to address health disparities in Connecticut in an efficient and cost-effective manner.”
demonstrating actual improvement.”
Local officials have concerns back to top
However, officials are concerned about both the quality and cost of services in the event the plan goes through.
The notion of heavily reducing the number of health departments in the state has raised several concerns for towns, Kevin Maloney, spokesman for the Connecticut Conference of Municipalities, said.
Among them are “the notion of a big cost increase, which would increase prices drastically,” and that “supervision of the consolidation without direct municipal supervision does not look adequate,” Maloney said. “These are issues that municipal leaders will want to address.”
Funding for this proposal would see a potentially costly change, Catlett added. Instead of individual towns budgeting for individual departments or contributing toward a regional effort, each town would need to contribute 1.5 percent of its overall budget, including education.
Under that standard, spending in most towns would climb dramatically.
Manchester, for instance, has budgeted about $850,000 for its Health Department this year. Based on the current fiscal budget of $183.5 million, regionalization would require its spending to increase more than three times, to approximately $2.75 million.
Municipal health service contributions for community-based departments also could see prices increase.
“As currently proposed, municipal contributions to support local public health services could increase significantly, over 200 percent for some of our member towns,” said Robert Miller, director of health for the Eastern Highlands Health District.
That district covers 10 towns, including Andover, Bolton, Coventry, and Tolland.
“Early rough calculations for our member towns show at least a four-fold increase in annual contributions,” said Patrice Sulik of the North Central District Health Department, which services eight towns including Enfield, Windsor Locks, Vernon, and Stafford.
“This approach pushes the bill onto the towns while removing most of the input and authority a town would have with relation to their public health services,” she continued.
Services also could be impacted in departments around the state. Catlett said any regionalization efforts likely would lead to a reduction in both provided services to towns and access to services for residents.
In Manchester, that could mean public health information and inspections of restaurants or drinking water could be reduced or changed in the regional concept, while flu shot clinics, health education, and emergency preparedness for residents would be decentralized and focused on Hartford County.
Some towns may see a tremendous impact on health infrastructure, Catlett said. Others, especially smaller towns, may actually see an increase in service access compared to current resources
District-based departments may experience even larger changes.
Should the county-based proposal go forward, “the county plan would sever our district into three different counties,” Sulik said. “All of the partnerships and collaborations and historical knowledge (of the department) would be affected,” she said.
“Basic services would be covered,” Sulik said. “Additional services that are not required, such as housing inspections and social services (embedded in some health departments) will need to be contracted out by towns for additional cost.”
Employment in different departments also could be affected, though “the current proposal stipulates that existing, full-time staff become employees of the new health district,” Miller said.
Many health leaders and districts in the area have either started or planned discussions about the potential ramifications of this move, and many plan to be vocal about its effects.
On a larger scale, regionalization continues to raise questions. Sulik mentioned that a lack of larger-scale governance complicates the issue further.
“Other states have county departments, but they also have county government,” she said.
Connecticut abolished county government in 1959 as state leaders saw it as ineffective.
“I think there is so much more that the state could do to improve local public health services,” Sulik continued. “They do not appear to have a detailed and thoughtful plan of how to proceed. … The state spent a lot of time encouraging the development of districts, many regions developed districts. Now they want to take them apart, without demonstrating actual improvement.”