Another quick departure from Health Dept.

By Jeffrey Barg

On February 19th Physician’s News Digest broke the story that Pennsylvania’s first physician general, Wanda D. Filer, M.D., gave the governor one week’s notice after only 15 months on the job. Sadly, it has been only two years since the department’s previous top doc, then-Secretary of Health Peter J. Jannetta, M.D., resigned less than a year after his conformation.

Is this merely a coincidence of two physicians who so missed taking care of patients that they could not tolerate serving a few years as high-ranking government officials? Or is this a sign of serious problems in the state Health Department?

Filer left little doubt that she was missing more than additional patient care responsibilities. She said in an interview with Physician’s News Digest that she had become tired of the conflict with the Ridge administration over her speaking out candidly about the health care needs of Pennsylvanians.

To be fair, problems in the Health Department predate the Ridge administration. The Jewish Healthcare Foundation of Pittsburgh released a report in 1994 stating:

• The department has been held in almost universally low regard in Harrisburg; recent secretaries of health have had little access to or influence with the governors they serve.

• The secretary of health is not recognized as the state’s primary spokesperson on health issues; responsibility for executive branch policy planning and articulation is widely diffuse.

• Department data systems, data analysis and data planning capacities are insufficient and fragmented.

• Staffing and professional resources are inadequate in key areas such as managed care oversight and health promotion.

• The department has become compartmentalized and correspondingly inefficient and inflexible; it is understaffed in critical areas of professional expertise, including physicians and epidemiologists.

And now the department’s shortage of physicians starts at the top: it has no physician general and the secretary of health is for the first time not a physician.

Does this really matter? Is the low priority afforded the Health Department appropriate?

We are living through an extraordinary transformation in our health care system. What once was the province of local not-for-profit hospitals, health insurers and individual physicians is increasingly becoming a market-driven enterprise of huge hospital systems, merged insurers and physician groups under the dictates of managed care. The Ridge administration and the General Assembly are appropriately considering new safeguards to ensure that patients’ best interests are not lost in this new health care system. But even if these safeguards are well conceived and well drafted, will the Health Department be in any position to implement them?

Ironically, in a time when controlling health care spending is a prevailing preoccupation of all, including state government, the science of population medicine, a long-time staple of public health, is probably the only alternative or corrective for the excesses and administrative burdens of managed care. This approach includes an assessment of the health needs of a population, followed by planning and the allocation of resources to meet these needs with special emphasis on health promotion and disease prevention. This approach would require investing more resources in the Health Department as well as more collaboration with the private health care system.

With the state and federal governments facing budget surpluses, would this be such an unreasonable investment?