Determinations Growth and Population

Purpose: To evaluate service needs based upon existing and anticipated growth patterns and population projections. Population within the Pittsburg/Bay Point area will increase to an estimated 112,600 people by 2035, with an average annual growth rate of 1.1 percent. These residents will need adequate healthcare services within the local area.

The District’s service area has a significant pediatric population (0-15 years) as well as adults in the 25- 34 age range and those over 65 years old. Each of these groups has specific healthcare needs.

Infrastructure Needs or Deficiencies

Purpose: To evaluate the infrastructure needs and deficiencies in terms of supply, capacity, condition of facilities, and service quality.

The LMCHD owns and leases the Pittsburg Health Center (formerly the Los Medanos Community Hospital) to the County. Per the terms of the lease agreement, the County is responsible for improvements and maintenance. The facility is in good to excellent condition.

The District’s other services are provided through funding support for programs and services of other healthcare service providers. The District conducts ongoing monitoring of health conditions within its service area and re-evaluates programs and priorities as part of its strategic planning process. The District is able to structure its programs to address specific healthcare issues and unmet needs.

Financing Constraints and Opportunities

The LMCHD is funded through a portion of the 1 percent property tax. This is a stable source of revenue.

Through prudent financial management the District will retire a long-term debt associated with the 1994 bankruptcy in 2007, five years earlier than required. This will reduce cash needs by $250,000 per year, and relieve the taxpayers of interest on the long-term debt.

The District structures its budget to match the anticipated property tax revenues and does not plan to incur additional long-term debt.

The District does not have restricted reserves or adopted policies for reserves. Given that the District has an increasingly important role in funding healthcare services for the Pittsburg/Bay Point area, the Board should consider reserve policies that would ensure available financial resources for program stability.

Cost Avoidance Opportunities

Purpose: To identify practices or opportunities that may help eliminate unnecessary costs.

The LMCHD collaborates with the County and other healthcare providers to leverage facilities, services, and programs.

The District should work with the County to ensure that the County is meeting its leasehold obligations for compliance orders on the Pittsburg Health Center.

Opportunities for Rate Restructuring

Purpose: To identify opportunities to impact rates positively without decreasing service levels.

The LMCHD does not charge fees for service. Given the District’s financial stability, the District should be able to avoid tax rate increases through continued prudent financial management.

Opportunities for Shared Facilities

Purpose: To evaluate the opportunities for a jurisdiction to share facilities and resources to develop more efficient service delivery systems.

The LMCHD shares facilities with Contra Costa Health Services, and provides funding support for programs in the Bay Point Health Center and Los Medanos College. The District has leveraged

opportunities to collaborate with other service providers and form partnerships that enhance the level of healthcare services provided within the District’s service area.

The LMCHD has hired an experienced Executive Director to manage the District. The District operates with limited staff. This management leadership will enable the District to maintain its financial stability and implement its strategic plan.

Government Structure Options

Purpose: To consider the advantages and disadvantages of various government structures to provide public services. Four government structure options were identified:

ƒ Status Quo: Advantages are that it would allow the residents to benefit from the financial stability and increased service levels that have been achieved over the past few years.

Disadvantages are that the District has a history of financial issues, including bankruptcy, and there is a concern that property tax revenues are not providing significant benefit to the area. ƒ Dissolve the LMCHD: Advantages include a potential reduction in District overhead expenses

and avoiding any duplication of effort with other service providers. Disadvantages include potential redirection of property tax revenues from healthcare to other services and programs that may or may not be within the local area. Given the documented health issues and level of unmet needs, this loss of funding would result in a significant impact to healthcare services locally and countywide.

ƒ Consolidate the LMCHD with the Mt. Diablo HCD: Advantages include potential service level improvements within the Mt. Diablo service area and cost reductions such as board expenses, overhead, and election costs. Disadvantages include no actual or limited cost savings, little improvement in service efficiency, and political opposition.

ƒ Dissolve the LMCHD and form a Subsidiary District with Limited Powers: Advantages include elimination of future election costs for directors, but there would be significant costs involved with dissolving the LMCHD and forming a new subsidiary district. Disadvantages include no actual or limited cost savings, little improvement in service efficiency, and political opposition.

Local Accountability and Governance

Purpose: To evaluate the accessibility and levels of public participation associated with the agency’s decision- making and management process.

The LMCHD encourages public participation by making District information and documents available on the District website and holding meetings that are open and accessible to the public.

Recent elections have been contested, with both incumbents and new candidates running for open seats. This is evidence of public interest in District management and operations.