By Tim Bonfield
The Cincinnati Enquirer

Some say improving Cincinnati's health care system requires a new level of involvement from business leaders.

Some say an open public forum is needed to get a wide cross-section of the community involved.

Some say the problems facing health care in Cincinnati are so big that it will take action at the state and federal levels to make a difference.

But regardless of disagreements over who should decide what the solutions should be, there is a growing consensus that something needs to be done.

"Just like downtown development, the stadiums or education, the business community needs to apply the same kind of muscle to health care as has been applied to other issues. It's that big." said Russell Dean, executive director of the Academy of Medicine of Cincinnati.

Last week, a task force of business and health care leaders released a report finding the supply of doctors in Greater Cincinnati lagged significantly behind 10 other Midwest cities in 14 of 33 fields.

THE COLLABORATIVE

• The Health Improvement Collaborative of Greater Cincinnati was formed several years ago to take on limited health projects, such as an annual flu shot campaign and an awareness project on depression in the workplace. Its 23 trustees for 2003 are: • Chairman: L. Thomas Wilburn, former CEO of TriHealth. • Vice-Chairman: Dick Aft, former president of the United Way and Community Chest. • Members (including ex-officio members with voting rights): • Paul Beckman, Anthem Blue Cross and Blue Shield • Roberta Bradford, Drake Center • Aurora Lambert, Health Alliance of Greater Cincinnati • Karen Licitra • Ethicon Endo-Surgery • Dr. Roslyn Kade • Tom Brady, United HealthCare of Ohio • Sister Barbara Busch, Working in Neighborhoods • Melody Robinson, Fifth Third Bank • Dr. Nora Zorich, Procter & Gamble • James Pearce, Hill Top Research • Larry Savage, Humana/ChoiceCare • David Jimenez, Mercy Health Partners • Dr. Stephen Cleves, Queen City Physicians • Dr. Inayat Malik, the Urology Group • James Duane, OKI Regional Council of Government • Alicia Reece, Cincinnati City Council • Russell Dean, Academy of Medicine of Cincinnati • Michael Fisher, Greater Cincinnati Chamber of Commerce • Lynn Olman, Greater Cincinnati Health Council • Robert Reifsnyder, United Way • Robert Steffel • HealthBridge.

The supply of nurses also was 19 percent lower here than elsewhere in the Midwest. Hospital fiscal health also was in worse shape.

While the report offers some fresh numbers, people inside the health system have been raising concerns for as long as two years.

Cash-strapped hospitals have struggled to hire nurses, closed operating rooms for lack of anesthesiologists, and declared record numbers of ambulance diversions to ease demand on crowded emergency departments.

Doctor groups have struggled to replace partners who leave town for big raises in smaller towns. And they warn that the supply concerns will get worse within five years because so many doctors who haven't left town are nearing retirement age.

"I'm amazed that more people aren't concerned by the fact that sometimes we have to send patients to Dayton and Louisville to get care when it used to be the other way around," Dean said. "I do not think it's a good idea to have Cincinnati relegated to a second-tier medical community."

Next steps

As talk turns toward what to do about the health care system, one group is likely to play a more central role - the Health Improvement Collaborative of Greater Cincinnati.

Formed several years ago to address selected topics of community concern, the Health Improvement Collaborative includes representatives from the physician, insurer, employer, hospital, government, education and consumer sectors.

Its projects have included an annual flu shot campaign and efforts to raise awareness about depression, low birth-weight babies, and proper diabetes care.

The collaborative hasn't envisioned itself as a forum for debating issues such as physician supply, but it may be headed that direction, said Lynn Olman, a trustee of the collaborative and president of the Greater Cincinnati Health Council, a hospital interest group.

"Maybe the collaborative could serve as a neutral forum for people to come together," Olman said. "There really isn't any other entity that cuts across so many of the groups."

Whether the collaborative will be the right group, or the only group, to take on health issues remains to be seen.

Doctors want more high-level business involvement than they have seen so far - despite the Cincinnati Business Committee's co-sponsorship of Monday's report.

"I think there are some people in the business community who are concerned about the system. I also think there are some who are satisfied with the status quo," Dean said.

But if community-wide health planning is to be done, consumer groups want a seat at the table - and a process that's open to the public.

"In terms of gathering data, there wasn't much reason for us to be involved. But in terms of looking at solutions, some consumer representatives should be involved, whether it is us or somebody else," said Dave Scharfenberger, administrator for the Working in Neighborhoods Senior Action Coalition, a group affiliated with Families USA.

"Some kind of open forum at some point could be beneficial," he said.

E-mail tbonfield@enquirer.com