The obscure Illinois Health Facilities Planning Board is mired in scandal again and in the cross hairs of the leaders in Springfield. Yes, it’s a depressingly familiar and extremely disturbing story.
On Wednesday, the Tribune reported that the board, which grants permission to build or expand hospitals and other medical facilities, was “riddled with potential conflicts of interest and more often than not ignores the recommendations of its professional staff.” The board rarely says no, especially if the right politically connected attorneys and lobbyists are hired to promote a project. That strongly echoes complaints detailed in this newspaper in 1999.
The legislature had a chance in 2000, and again in 2003, to kill the board entirely. Instead, it passed incremental reforms but shrank from more radical suggestions that the board be abolished. Too bad.
The board has had some 30 years to prove that it’s effective in its mission to control health-care costs. It has failed. It has mainly succeeded in offering a continuing opportunity for clout-heavy lawyers, consultants and lobbyists.
In recent weeks, a federal investigation of the board was revealed amid new allegations of shakedowns, corruption and cronyism.
Enough. It’s time to follow the lead of many other states: Shutter the board.
A bill to replace the nine members of the board with a new, five-member panel recently passed the Illinois House. But that would simply grant another reprieve to a failed institution. A better idea is a bill introduced by three Republican state senators, Kirk Dillard, Steve Rauschenberger and Christine Radogno, to terminate the board immediately. That’s similar to a bill introduced by state Rep. Beth Coulson that would terminate the board in January.
Since the 1980s, 24 states have jettisoned their hospital-expansion regulation programs, according to the American Health Planning Association. Of those, 14 have dropped all programs that required companies to get permission for many projects via what is known as a certificate of need. Those states have recognized that the boards are an unnecessary vestige of the past.
In the 1970s, states hoped to control medical costs by forcing companies to prove that hospital expansion or other major medical projects were necessary. That was before managed care, when the federal government and many insurers paid bills without much question. Even so, most studies found that certificate-of-need programs exerted little influence on soaring medical costs.
Many local hospitals staunchly support the board’s purpose and continued regulation as a way to protect against potential interlopers like so-called “niche” or specialty hospitals, which focus on a narrow range of illnesses or treatments, or the for-profit hospital giants.
Their most potent argument: Unbridled competition could skim away the most affluent customers, endangering some hospitals that serve significant numbers of the poor, the uninsured and the underinsured.
That’s a valid concern. But there’s little evidence that the board has ever exerted much influence on those complicated market dynamics. Medicaid reimbursement rates, among other factors, are likely to be far more influential.
A 2001 Illinois auditor general’s audit of the board said the health-care research literature either didn’t consider or “showed little evidence” of any positive effects on access, or how well hospitals serve the poor and uninsured. That’s logical. After all, the board can’t force hospitals to build in poorer areas, or stop hospitals with shaky finances from going out of business. In Illinois, 49 hospitals have been closed since 1982.
All the board can do is strangle competition.
Killing the board could bring new competition and lower costs to Illinois. The results probably won’t be all positive. That’s reason for vigilance. Even some critics of the board say that some oversight and regional planning may be necessary to stop predatory practices and promote quality and access for the poor.
If there are unforeseen negative consequences–if, for example, hospitals are closing and medical care fleeing from poor and underserved areas–it can respond with new, narrowly focused initiatives. What Illinois won’t have–and doesn’t need–is a scandal-scarred board that is part of the problem, not the solution.
