Maxwell Perspective: Syracuse, Health Care
July 7, 2012
The Pulse of the City
If Syracuse is especially blessed in any one sector, it is health care. And yet, the challenge to provide for all is never met and some people go without.
St. Joseph’s Hospital
Health care delivery is a competitive business that occasionally gets in the way of health planning. But in Syracuse, decisions made on economic practicalities have resulted in a health care system that provides high quality care to a broad geographic region and also is a driving element of the economy.
“Health care makes an enormous economic contribution to this community,” says Tom Dennison, director of Maxwell’s program in Health Services Management and Policy. “SUNY Upstate Medical University is the largest single employer and health care is the largest industry sector employer in the county.”
This is accomplished with far fewer hospital beds than is typical. “You could find nine hospitals in a city this size,” says Kathy Ruscitto ’92 MA (PA), president and CEO of St. Joseph’s Hospital Health Center, one of four Syracuse hospitals.
At one time in the not so distant past, Syracuse had 13 hospitals, all vying for support from the area’s manufacturing industry.
“Corporate leadership, which was essentially picking up the tab, basically said, ‘We’re not going to fund all of you. Figure out a way to collaborate,’” says Dennison. “As a result, Syracuse became a hotbed of health planning, long before it was in vogue across the country.”
There are now four hospitals in Syracuse, and decisions made about consolidating and coordinating care have been good ones. “We are really lucky in this community to have had a health care system developed over the years that is very efficient, high quality, and low cost,” says Ruscitto.
The CEOs of the hospitals form the Hospital Executive Council (HEC), which meets regularly to discuss community needs and joint ventures. When St. Joseph’s psychiatric emergency department was in crisis several years ago, HEC discussions led to it becoming a joint venture of the hospitals. Now St. Joe’s runs it and splits the deficit with University Hospital. “We would have had to close it without that support,” says Ruscitto.
If there is one particular problem in the community, it is in mental health care.
“The licensed clinical psychiatric services are full,” says Ken Mack ’02 BA (Soc), director of community outreach programs for Transitional Living Services in Syracuse, which provides support services to help individuals avoid needing inpatient services. “It’s hard to find a therapist or psychiatrist and it’s become even more complex because of the changing needs of an aging population.”
“The strength of Syracuse is that people can come here with nothing and make a life.”
People with psychiatric disabilities are often unemployed and without health insurance, except for Medicaid, which severely limits their ability to access services. “A lot of doctors either don’t take Medicaid or are cutting back. It makes it hard for patients to both find a doctor and stay with them,” says Mack.
Overall, for all types of health care, the “two-tiered system” — Medicaid and commercial insurance — is a challenge, Ruscitto says. “We still don’t have equal access for all.”
Many of those affected are Syracuse’s urban residents — refugees, the working poor, and the unemployed. “The economic situation of the city has had an impact on the number of inner city residents experiencing health care problems that are not managed — asthma and obesity, for example,” says Ruscitto. “It’s not just enough to have a health care clinic; there are not good grocery stores in the inner city.”
These are issues under study by the Commission for a Healthy Central New York, a community-wide initiative spearheaded jointly by the Maxwell School and Upstate Medical University. “We have identified issues related to access of care for the uninsured, with specific focus areas on maternal and child care and refugee populations,” says Dennison, who chairs the commission.
Those aren’t problems unique to Syracuse, nor are they easy to fix. But Ruscitto believes Syracuse’s size is a plus when it comes to tackling tough health care issues. “I think you’d find those same challenges in Buffalo and Rochester,” she says. “The difference here is that we’re small enough that we can really be focused on trying to solve some of these challenges.”