The Fall and Fall of the NYCDOH
JThe New York City Department of Health,
once perhaps the leading public health department
in the country, has recently become another in
the growing list of victims of this city's fiscal
crisis. In the following article, some of the dyn-
amics of the recent, rapid decline are outlined
against the background of the Department's long,
proud history. The article is condensed from
Health/PAC's recent report, Preventive and Pri-
mary Care During the New York City Fiscal
Crisis: 1974-1978 (available from Health/PAC).
The report is one product of an 18-month study
funded in part by the Samuel Rubin Foundation
and the New York Community Trust.
The article covers the years 1974-1977. It does
not, therefore, cover more recent events which
have seen the Department pushed to the brink
of extinction. For example, the City's Health and
Hospital Corporation (HHC) (the troubled, quasi-
public agency that administers the City's 17 mu-
nicipal hospitals) has recently developed a plan
to absorb many of the remaining operations of
the Department of Health (DOH). Given the
desperate search by HHC for inpatients
to fill its many empty beds, combined with the
mounting shortfalls in HHC revenues, many
predict that the public health orientation of these
DOH services would be lost should such a trans-
fer materialize.
More recently, DOH officials-under mandate
from City Hall to cut even deeper into their city
tax levy funding-have begun to plan for the
billing of non-Medicaid patients on a sliding fee
scale as a means of revenue enhancement. This
proposal was denounced by the Public Health
Association of New York City (PHANYC) in
a letter to Mayor Koch as being "contrary to the
public interest." Such billing, PHANYC pointed
out, has been shown to discourage use by the
"working poor" (those ineligible for Medicaid
and uncovered by private insurance or other means
to pay and perhaps total 1.5-million New Yorkers),
who, given their marginal incomes, rarely view
preventive services as a top priority. A sliding
fee scale would thus be counterproductive as it
"will surely put these services out of reach for
thousands of New York families."
Such recent moves, and the policies pursued