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1976/03/30 - New York State County Executives
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1976/03/30 - New York State County Executives
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The original documents are located in Box 57, folder "1976/03/30 - New York State County Executives" of the James M. Cannon Files at the Gerald R. Ford Presidential Library. Copyright Notice The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Gerald Ford donated to the United States of America his copyrights in all of his unpublished writings in National Archives collections. Works prepared by U.S. Government employees as part of their official duties are in the public domain. The copyrights to materials written by other individuals or organizations are presumed to remain with them. If you think any of the information displayed in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential Library. Digitized from Box 57 of the James M. Cannon Files at the Gerald R. Ford Presidential Library MEETING WITH NEW YORK STATE COUNTY EXECUTIVES Tuesday, March 30, 1976 4:30 p.m. Mr. Cannon's Office Mar 30 March 9, 1976 4:30 Mr. Cannon: Ralph Caso, County Executive from Nassau County, along with elected officials from 5-6 other New York counties, would like to meet with you regarding welfare and Medicaid problems in New York State along with the general financial picture facing New York State. They had requested a meeting with the Vice President, but he will be out of town during that time. They plan to be here March 29, 30, j Quine 31. Johnson and/or I WILL SEE THEM (w/ McConahey HAVE THEM SEE McConahey instead. John Fasso (or secretary) Nassau County, Washington representative 785 9577 PHONE (202) 785-9577 STATE COUNTY STATE OF This mg. JOHN J. FASO WASHINGTON REPRESENTATIVE COUNTY OF NASSAU 1735 NEW YORK AVE., N.W. FEDERAL AND STATE AID SUITE 502 WASHINGTON OFFICE WASHINGTON, D. C. 20006 Newsday 3/19/76 THE ISLAND Counties Seeking Welfare Showdown Hauppauge-County executives from 11 New The resolution reads, "if during 1977 the counties "We have the Cadillac system of social services in York counties, including Suffolk and Nassau, agreed are judicially ordered to expend greater amounts than New York State," Klein charged. "If you are a two- yesterday to freeze their 1977 welfare spending at appropriated, the county executives will recommend person household in Suffolk County, you must earn 1976 levels. to their legislatures that compliance with such court $7,236 a year to be better off than if you ware to go on Their purpose, the county executives admitted, is orders be made by reducing expenditures for optional welfare. A four-person household must earn $11,172 a to force a confrontation between county governmen's county functions as opposed to borrowing such funds year. In contrast, the average four-member household and the state and federal governments. and thereby increasing property taxes for social serv- in New York State earns only $10,443 a year." A resolution was approved unanimously yesterday ices purposes." Westchester County Executive Alfred Del Bello by attending representatives of 11 of the 16 member Broome County Executive Edwin Crawford, the said, "The real property taxpayer in New York State counties of the New York State County Executives' association's president, said, "We have reached a has been punished more severely than any other tax- Association. It urges the State Legislature to freeze point in county government where we cannot continue payer in the United States in the amount of his dollar the county portion of welfare spending for 1977 at to tax our residents for higher and higher welfare support for welfare programs." 1976 levels but resolves that, if necessary the county costs." The Suffolk County Legislature's presiding officer, executives pose such a freeze themselves. The executives said they ultimately intend to ad- Floyd Linton (D-Miller Place), said last night that he Yesterday's resolution was so far-reaching that it dress Congress on the issue but that the first phase of supported the county executives' resolution. "It's a anticipated not only the likelihood of a court battle their attack was directed at the state because of the time for all of us now to work co-operatively to re- next year but the possibility that the counties might extra cost of New York social services programs which strict the pressure of social services costs on local gov- lose the battle. are not federally mandated. ernment," Linton said. -Fred Tuccillo RALPH G. CASO COUNTY ARE STATE KENNETH D. MOLLOY COUNTY EXECUTIVE FEDERAL & STATE AID COORDINATOR OF NEW OFFICE OF THE EXECUTIVE 1550 FRANKLIN AVENUE MINEOLA. N. Y. 11501 26 March 1976 Mr. James A. Cannon Director, Domestic Council The White House 1600 Pennsylvania Avenue, N.W. Washington, D.C. 20500 Dear Mr. Cannon: The following is a listing of New York State County Executives whom County Executive Caso has asked to join the meeting with you on 30 March 1976 at 4:30 p.m.: Ralph G. Caso - Nassau County Edwin Crawford - Broome County Louis Mills - Orange County John V.N. Klein - Suffolk County John Mulroy - Onondaga County William Bryant - Oneida County Ned Regan - Erie County Joseph Gerace - Chautauqua County John J. Faso - Washington Representative, Nassau County Mr. Caso and the other county executives are especially con- cerned with the severe fiscal problems associated with mandated welfare and medical assistance payments on the county level in New York State. For your information, I have enclosed a recent article appearing in Newsday detailing the welfare problems currently faced by New York counties. We look forward to meeting with you on Tuesday. Sincerely, John Faso Washington Representative The County of Nassau Washington Office 1735 New York Avenue, N.W. Washington, D.C. 20006 785-9577 NEW YORK STATE COUNTY EXECUTIVES ASSOCIATION NEW COUNTY OFFICE BUILDING/P.O. BOX 1766/BINGHAMTON, NEW YORK 13902 OFFICERS EDWIN L. CRAWFORD President Broome County Executive EDWARD V. REGAN RESOLUTION NO. XXXVI First Vice President Erie County Executive JOHN V. N. KLEIN RESOLUTION OF THE NYS COUNTY EXECUTIVES ASSOCIATION Second Vice President Suffolk County Executive ALFRED DELBELLO Treasurer Westchester County Executive Resolution urging New York State to immediately take action to freeze the county dollar contri- MEMBERS bution of social services programming by county government at 1976 expenditure levels. RALPH G. CASO Nassau County Executive Past President LOUIS V. MILLS Orange County Executive Past President WHEREAS, New York State imposes on county governments WILLIAM H. BARTLES the most costly social services program in Dutchess County Executive the nation; and DR. MORRIS BLOSTEIN Chemung County Executive WHEREAS, most counties in New York State now spend WILLIAM E. BRYANT over 50% of their budgets for these legis- Onelda County Executive lated social services programs requiring cuts JOSEPH GERACE in essential county services; and Chautauqua County Executive LUCIEN A. MORIN WHEREAS, the increasing costs in these social services Monroe County Manager programs will inevitably bankrupt the counties; JOHN H. MULROY and Onondaga County Executive WILLIAM J. MURPHY Rensselaer County Executive WHEREAS, these costs are almost exclusively reflected in real property tax increases which can no CARL F. SANFORD Schenectady County Manager longer be borne by the taxpayers of the counties; and WHEREAS, the counties have no control over these legis- lated social services programs; and WHEREAS, the New York State Legislature yesterday ad- dressed itself to welfare and Medicaid reform which will result in little or no relief to county taxpayers, NOW, THEREFORE, BE IT RESOLVED, that the New York State County Executives Association urges New York State to immediately take action to freeze the county dollar contribution of social ser- vices programming by county government at 1976 expenditure levels, and BE IT FURTHER RESOLVED, that the County Executives of Nassau Suffolk Westchester Monroe Broome Onondaga Dutchess Oneida Erie Chautauqua Rensselaer have unanimously agreed that each such Execu- tive will recommend to each of their County Legislatures in their counties' 1977 Budget appropriations for social services purposes no greater amount of funds than anticipated expenditure levels for 1976, and BE IT FURTHER RESOLVED, that if during 1977 the counties are judicially ordered to expend greater amounts than appropriated, the County Executives will recommend to their Legislatures that compliance with such court orders be made by reducing expenditures for optional county functions as opposed to borrowing such funds and thereby increasing property taxes for social services purposes, and BE IT FURTHER RESOLVED, that the New York State County Executives Association will develop and deliver to the Governor and legislative leaders in the immediate future a two-part package of state welfare administrative and legislative reforms for immediate implementation, and BE IT FURTHER RESOLVED, that the President of the Asso- ciation shall immediately notify the County Executives of Orange, Niagara, Albany, Chemung and Schenectady of the action taken by this Association at this special meeting and to re- quest each Executive's concurrence so that this Association will be unanimously in support of the Resolution adopted at this meeting, and BE IT FURTHER RESOLVED, that the President of this As- sociation be directed to present this Resolu- tion to the Board of Directors' meeting of the New York State Association of Counties to be held at Syracuse, New York, on March 22, 1976, and that he further request said Board to adopt a Resolution on behalf of all counties in New York State in support of the provisions of this Resolution, and BE IT FURTHER RESOLVED, that the President of this As- sociation requests the New York State Associa- tion of Counties Board of Directors and its Resolutions Committee to present a general Resolution to the Spring Seminar of NYSAC on April 4-6, at Monticello, New York, which would be acted upon by the member counties in the Business Session of the Seminar, containing essentially the same provisions as the Resolu- tion adopted on this date by the New York State County Executives Association with the hope and expectation that each county in the State of New York will eventually make a commitment to support the provisions of this Resolution. Adopted 3/18/76 Suffolk County, New York NASSAU COUNTY DEPARTMENT OF SOCIAL SERVICES COST COMPARISON MEDICAL ASSISTANCE - TOTAL DEPARTMENT TOTAL EXPENDITURES MEDICAL ASSISTANCE PERCENTAGE YEAR DEPT. OF SOC. SVC. EXPENDITURES* (MA VS. TOTAL) 1971 149,896,000 65,043,100 43.4 1972 157,803,000 69,742,500 44.2 1973 163,527,000 77,005,100 47.1 1974 168,184,400 90,537,700 53.8 1975 190,240,195 107,466,500 56.5 1976 Budgeted Cost 210,959,020 114,122,900 54.1 CASELOAD STATISTICS End of: Public Assistance Medical Assistance Total Cases Individuals Cases Individuals Cases Individuals 1973 21,778 47,229 11,830 17,106 35,042 65,769 (included AABD) 1974 11,809 35,888 20,777 24,358 33,921 61,581 1975 11,695 34,884 21,240 24,773 34,297 61,019 Feb. 1976 11,566 34,414 21,200* 24,800 34,124 60,672 * Includes about 12,000 SSI cases automatically eligible for MA (see attached Exhibit C for detailed breakdown of Public Assistance -- ADC and HR) NASSAU COUNTY DEPARTMENT OF SOCIAL SERVICES COST COMPARISON MEDICAL ASSISTANCE - TOTAL DEPARTMENT TOTAL EXPENDITURES MEDICAL ASSISTANCE PERCENTAGE YEAR DEPT. OF SOC. SVC. EXPENDITURES* (MA vs. TOTAL) 1971 149,896,000 65,043,100 43.4 1972 157,803,000 69,742,500 44.2 1973 163,527,000 77,005,100 47.1 1974 168,184,400 90,537,700 53.8 1975 190,240,195 107,466,500 * 56.5 1976 Budgeted Cost 210,959,020 114,122,900 54.1 * MEDICAL EXPENDITURES RELATED TO CLIENT POPULATION % of % of Aged Population Med. Cost Total DSS A. Holly Patterson Home 13,587,201 12.6 7.1 Old Age Assistance 47,966,000 44.6 25.2 Aid to Blind 289,000 0.3 0.2 Aid to Disabled 15,747,000 14.7 8.3 Total Aged 77,589,201 72.2 40.8 Aid to Dependent Children 19,445,000 18.1 10.2 Home Relief 7,387,000 6.9 3.9 Foster Care 751,000 0.7 0.4 Medical Per Diem, Transportation 2,294,299 2.1 1.2 107,466,500 100.0 56.5 MFT 3/25/76 CASELOAD STATISTICS (C) TOTALS FOSTER ELIGIBLE End ADC HR TOTALS MA- ONLY CARE FOR MED. ASST. of Cases Indiv. Cases Indiv. Cases Indiv. Cases Indiv. Cases Indiv 1973 10,247 33,627 1,582 3,411 21,778 47,229 11,830 17,106 1,434 35,042 65,769 (Inc. AABD) 1974 9,650 31,736 2,159 4,152 11,809 35,889 20,777 24,358 1,335 33,921 61,581 1975 9,322 30,747 2,373 4,137 11,695 34,884 21,240 24,773 1,362 34,297 61,019 Feb. 1976 9,219 30,319 2,347 4,095 11,566 34,414 21,200 24,800 1,358 34,124 60,572 PRELIMINARY REPORT ON TRENDS IN NASSAU COUNTY EXPENDITURES FOR PERSONAL HEALTH SERVICES 1950 - 1974 RALPH G. CASO COUNTY EXECUTIVE MARCH 1976 PRELIMINARY REPORT TRENDS IN NASSAU COUNTY EXPENDITURES March 1976 FOR PERSONAL HEALTH SERVICES 1950 to 1974 PURPOSE A number of studies have been made on the national level of the growing costs of health care services and of the impact that Medicare and Medicaid legislation has had on per capita expenditures for health care over the past decade. With the increasing possibility that National Health Insurance will be passed in the "near" future, there has been additional concern about what may happen to medical care costs if adequate safeguards are not built into the proposed legislation. Over the past 24 years expenditures by government agencies in Nassau County who are responsible for either the delivery of or payment for health services increased from 3 million dollars for 1950 to over 168 million in 1974. While expenditures for personal health services were only 13% of the County's general fund expenditures in 1950, by 1974 they comprised 30% of the County's expenditures. The purpose of this analysis is to identify the extent to which these trends at the local level are the result of: increases in County population increases in the overall cost of living, and/or increases in medical care costs increases in services provided It should also serve to identify the extent to which Nassau County is involved in the medical care delivery system and thereby provide a basis to estimate the effect that National Health Insurance may have on County expenditures. METHOD Data on expenditures, revenues and services was collected for the period 1950 to 1974 by the following Nassau County agencies: Department of Health (excluding Environmental Health services) Department of Mental Health Department of Social Services (expenditures for Medicaid and for the Holly Patterson Nursing Home only) Nassau County Medical Center (excl. Plainview Division) Plainview Division ( N.C.M.C.) Department of Drug and Alcohol Addiction Expenditures Expenditures, for each of the agencies, include: direct administrative costs (for the Health Department and for Social Services, it includes an allocation of Department administrative costs in proportion to their expenditures for personal health services.) costs of contractual arrangements for providing services (Mental Health and Drug & Alcohol Addiction) (2) The following items were not included in the expenditure figures: employee fringe benefits cost of services provided by other County agencies (e.g. such indirect costs as allocation of Comptrollers Office and computer costs, rent and maintenance in lieu of rent, telephone etc) grants and special contracts for projects fully funded by the Federal or State government (e.g. Cooperative Health Statistics System, Hypertension Seek & Treat, Women's Health Screening, Lead Poison Control) While the attached tables present total County expenditures as the sum total of the expenditures of the individual agencies, for the purpose of analysis, total expendi- ture figures were developed which exclude "Medicaid" duplication - i.e. those expenditures for services for Medicaid patients made by County agencies which were paid for by the Department of Social Services, under the Medicaid program. Where the agencies provided detailed data on the sub-programs for which expenditures were made (e.g. expenditures for home care, clinic and other personal health programs provided by the Health Department), these are shown on the table for that department (tables IV to VII ). The dollar values for expenditures were converted to "real dollars" to eliminate the cost of living factor. The Consumer Price Index for the New York Area (with 1967 as the base year) was used as the basis for conversion (see Appendix A). It is recognized that County expenditures (other than Medicaid) were largely for salaries, which were increased over the years as a result of contract negotiations. Broadly speaking, the cost of living increases that were awarded to the employees were in keeping with the changes in the Consumer Price Index (See Table II for expenditures in "real" dollars) "Real" expenditures were further converted to an index, using 1967 as the base year. This was done to permit comparison between agencies, as well as comparison of trends in expenditures with trends in services provided. (See Table III) Revenues Revenues were identified as Federal, State or Departmental. The latter includes Medicaid, Medicare and receipts from 3rd party payors. More detailed information on revenues, insofar as it was available, is shown on the tables for each of the agencies. One of the problems in dealing with revenues is that they are reported as of the year of receipt. This means that revenues received at the beginning of one year may actually apply to expenditures in a previous year. While normally this balances out, there appear to be several sharp variations in revenues, as a proportion of expenditures, that are questionable (particularly in the Department of Social Services). As with expenditures, revenues were also presented in "real" dollars and as an index of the base year 1967. Services Provided A number of key program outputs were designated for each of the agencies - i.e. number of visits, number of tests, number of clients, number of hospital bed days. Where applicable, these were shown as rates per 1,000 population. It is recognized that the outputs included in the report are only a partial indication of the services and functions provided by the agencies. Output measures were not included for such services as health education, research activities and communicable disease control. (3) EXPENDITURES Overall Trend County expenditures for personal health services increased steadily from $3 million in 1950 to over $168 million in 1974. Different factors accounted for the increases at various points in time: between 1950 and 1960, expenditures more than tripled (from$3 million to almost$11 million), reflecting a major increase in County population (from 673,000 to 1,308,000) and expansion of County services. between 1960 and 1966, before Medicaid and Medicare, expenditures were almost doubled, increasing from $11 million to almost $20 million. During this period there appeared to be a continuing trend of increased services for a still growing population. The number of County residents increased from 1,308,000 in 1960 to 1,406,000 in 1966. Health Department Clinic Services were expanded. Mental Health increased its contractual arrangements for clinic services and started two clinics of its own. reflecting the impact of the Medicaid legislation in 1967, expenditures jumped in one year from $20 million in 1966 to $36 million in 1967 a). between 1967 and 1974, there was a continuing trend of increased expendi- tures for a fairly stable population; this trend was only partially accounted for by the rise in general consumer prices. In this 7 year period expenditures more than quadrupled - from$ 36 million in 1967 to $ 157 million by 1974a) The sharpest increases were evident in the Department of Social Services, where health expenditures rose from $16 million in 1967 to $98 million in 1974. Percent of Total County Expenditures A steadily increasing proportion of County Expenditures has been spent for Personal Health Services over the past 24 years. This was particularly apparent after 1965 and was almost entirely a result of the Medicaid program. Total Nassau Expenditures % Health Expenditures of Total Expenditures Year County General for Personal Fund. Expend. Health a) Total Health Medicaid All Other (millions of $) (millions of $) Expenditures Expenditures Health Expend. 1950 $ 25.0 (est) $ 3.3 13.2% - - 1960 72.7 10.9 15.0 - - 1965 129.4 18.5 14.3 - - 1970 327.3 77.5 23.7 12.1% 11.6% 1973 487.9 130.3 26.7 14.5 12.2 1974 522.5 156.6 30.0 16.0 14.0 a) excludes duplicate reporting of expenditures for Medicaid clients. (4) "Real" Dollar Expenditures Conversion of expenditures to "real" dollars, based on the general Consumer Price Index, revealed that the rise in County expenditures for health far exceeded the increases in general consumer prices. Furthermore, as shown by the trend in per capita "real" expenditures in the County, population growth was not a factor in the rising costs. NASSAU COUNTY'REAL'DOLLAR EXPENDITURES FOR PERSONAL HEALTH SERVICES Total Expenditures a) Per Capita Year (in Millions) Expenditures 1950 $ 4.7 $ 6.92 1960 12.5 9.55 1965 19.6 13.99 1966 20.4 14.49 1967 35.7 25.27 1968 55.2 38.92 1969 62.0 43.51 1970 65.1 45.59 1971 84.0 58.77 1972 88.8 62.11 1973 93.3 65.20 1974 101.2 70.71 As indicated above, the major increases in per capita"real"dollar expenditures for personal health services occurred in 1967, (with the introduction of Medicaid), in 1968 (with the initial expansion of the Medicaid program) and in 1971 (when D.S.S. expenditures for health jumped from $47 million to $71 million). On a national basis, annual increases in the Consumer price Index for Medical Care between 1965 and 1971 was at a higher rate than the overall Consumer Price Index. In 1972 and 1973, reflecting the effect of the wage-price controls on health services, medical care prices increased at a much lower rate. When these controls were lifted in April 1974, the national Medical Care Index again began to rise. a) See footnote page 3 (5) The following table indicates the effect of the freeze on the overall medical care index and on hospital charges: b) Annual Rate of Change in U.S. During Economic Item Stabilization Prefreeze Period Program Post E.S.P. Period, Feb. 1969-71 August '71 -April '74 April '74-June '75 Cons. Price Index all items 5.6 6.4 9.9 Medical Care 6.7 4.3 13.1 Semi-private Hosp. room charges 13.0 5.7 17.7 With D.S.S. expenditures for health services comprising more than half the County's outlay for personal health services, and with the cost of hospital care and physician's fees a major component of D.S.S. expenditures, it is not surprising that the County's health expenditures followed the national picture for medical care costs. REVENUES AND COST TO COUNTY Federal, State and Departmental revenues paid for less than half of the County's expenditures for personal health services prior to 1965. In 1960, State Aid and Department fees totalled $5.1 million (there were no Federal revenues reported); this represented 47% of the expenditures for health services. In 1967, $30.7 million were received in revenues, or 86% of the expenditures. This high rate was not maintained consistantly however. In 1974, the County appeared to be bearing as much as 44% of the cost of personal health services. The following table indicates the proportionate sources of revenues and cost to County for selected years since 1950. NASSAU COUNTY SOURCES OF PAYMENT FOR EXPENDITURES FOR PERSONAL HEALTH SERVICES 1950 - 1974 Total % Distribution of Payment Source Year Expend. a) Federal State Dept. a) (in millions) Total Revenue Revenue Revenue County 1950 $ 3.3 100.0% - 20.0% 12.6% 67.4% 1960 10.9 100.0% - 19.3 27.8 52.9 1965 18.5 100.0% - 19.8 31.9 48.3 1967 35.7 100.0% 26.9 33.9 25.3 13.9 1970 77.5 100.0% 29.1 23.0 15.8 32.1 1974 156.6 100.0% 20.5 21.5 14.4 43.6 a) See footnote page 3 b) Source: HEW Medical Care Expenditures Prices & Costs: Background Book - Sept. 1975 (6) Medicaid payments from D.S.S. to the 4 County agencies that provide health services to Medicaid clients increased from $6.1 million in 1967 to $11.9 million in 1974, with the Nassau County Medical Center a major recipient of Medicaid payments. In 1974 as much as 25% of the Medical Center's expenditures were covered by Medicaid reim- bursement. Similarly, payments from Medicare increased from $0.1 million to $7.9 million in 1974. The Medical Center received 7.3 million in Medicare payments in 1974; this comprised 20% of their expenditures for that year. Despite the fact that increasing revenues paid for a sizeable portion of the County's expenditures for personal health services, the tremendous growth in overall expendi- tures resulted in increased costs to the County. This was evident in "real" dollars as well as. actual dollars. Cost to County Cost to County Year in "Real" Dollars in Actual Dollars (in Millions) (in Millions) 1950 $ 3.1 $ 2.2 1960 6.6 5.8 1965 9.5 8.9 1966-1969 (aver. per year) a) 11.6 12.2 1970-1974 (aver. per year) a) 21.5 30.3 In 1974 the net cost to County in "real" dollars was $44.1 million - almost 10 times the amount for 1967. In actual dollars it reached $68 million in 1974. While increases in cost to County were apparent to some extent in all six agencies, by far the largest increases in the cost to the County were in the Department of Social Services. SERVICES PROVIDED Trends in services provided varied considerably among the agencies. Reflecting national trends in patient care costs, increases in "real" dollar expenditures for services did not necessarily mean that increased services were provided. "Real" dollar expenditures for personal health services by D.S.S. increased 60% between 1970 and 1974, while the number of clients eligible for medical assistance decreased 21.5%. Gains in services provided were noted in clients served by Drug & Alcohol Addiction, Mental Health clinic visits, Health Department clinic visits and in the weighted patient days at the Nassau County Medical Center. a) Averages are used here because of the fluctuation in Federal and State reim- bursements and the difficulty in relating to the year against which they applied. (7) ANALYSIS BY AGENCY The following is a brief analysis of trends in expenditures by the 5 Nassau County agencies responsible for providing personal health services. Department of Health While total expenditures more than doubled between 1967 and 1974 (from $3.1 million to $6.9 million), the net cost to the County increased only 8% (from $1.6 million to $1.7 million). This was largely the result of increased revenues from Medicare and Medicaid for home health and clinic services. Support of health services is provided through 50% State Aid, as well as special State funding for Medicaid Services Review and for the supervision and certification of hospitals and nursing homes. The following trends were noted in services provided: Home visits made by nursing and therapy staff reached a peak of 101, 433 in 1967 and declined to 52,370 in 1974. This was in keeping with the Departments' planned arrangement with the V.N.A.'S and Nursing Sisters for them to provide nursing coverage for specified areas of Nassau County. Clinic visits increased 48% from 47,379 in 1967 to 70,323 in 1974, reflecting the continued expansion in the types of clinic services offered and the number of clinic sessions held. Laboratory tests for personal health services declined between 1967 and 1970 (from 437,926 to 262,466) reflecting the institution for fees for certain types of tests (primarily cytology and prenatal). Expanded clinic services and screening programs contributed to an increase in tests performed between 1970 and 1974. Dept. of Mental Health In the Mental Health delivery system this department is the planner, innovator and evaluator of a host of services whose costs are partially paid for by the County. Total expenditures for mental health services increased from $4.6 million in 1967 to $15.3 million in 1974. The net cost to the County increased only $2.2 million during this period ,from $1.3 million to $3.5 million. The volume of patient services doubled between 1967 and 1974. The County operated programs have remained relatively stable over the years, serving the needs of the Family Court and Department of Social Services. The thrust of expansion took place in the area of contractual services, where the mechanisms for the delivery of services are more flexible. (8) Nassau County Medical Center Expenditures at the Medical Center excluding the Plainview Division, reached $37 million in 1974, more than 2 1/2 times the amount spent in 1967. The proportion of expenditures borne by the County has fluctuated from 27% in 1967 to a high of 30% in 1969, and back to 29% in 1974. For the year ended Dec. 31, 1975, based on a financial presentation consistent with prior years, there will be no County subsidy of expenses required for the Medical Center. With the advent of Medicare and Medicaid, the sources of revenues changed significantly. Prior to 1966, in-patient revenue was derived mostly from Blue Cross and Welfare (35% Blue Cross, 20% Welfare). After 1966, this was changed to approximately 20% Blue Cross, 40% Medicaid and 25% Medicare. In order to evaluate services provided between 1967 and 1974 we must first examine some of the components of these patient services. With new technology and knowledge in the delivery of hospital care at least four new major areas of care were added; these are: burn unit, renal dialysis unit, intensive care and coronary care units and the neo-natal unit. These units which began in the early 1970's are very high cost areas. Further, if one examines the patient load at the Medical Center (weighing the out-patient service in re- lationship tc a patient day) there was an 11% increase in service between 1967 and 1974 (from 209,531 weighted patient days in 1967 to 232,156 in 1974.) In addition, the occupancy rate for 1975 (83%) represented an increase over the 1974 rate (75%). However, the Plainview Division provided 48,774 in-patient days in 1967 compared to 8,895 in-patient days in 1974, or an 82% decrease in patient load, which is the reason this area is being closed. Increased expenditures for out-patient care were accompanied by increases in services provided. Expenditures for clinic and emergency room services more than tripled between 1967 and 1974 (in "real" dollars this represented an increase of 121%). During this period clinic visits increased 77% from 81,017 in 1967 to 143,554 in 1974. Emergency Room visits increased 52% from 45,094 in 1967 to 68,577 in 1974. In 1975 Emergency Room visits increased 11% over 1974 (1975 visits of 81,490 over 1974 visits of 68,577). Similarly 1975 clinic visits increased 8% over 1974 (154,626 in 1975 as compared with 143,554 in 1974). Department of Drug & Alcohol Addiction With the implementation and expansion of the Drug and Alcohol Addiction Program, expenditures increased from $520 thousand in 1969 to over $8 million in 1974. A major portion of the program is funded by Federal and State agencies (82% in 1974). The number of clients served, particularly by the sub-contract agencies, increased at a faster rate than total expenditures. Twenty five thousand clients were served by contract agencies in 1972, as compared with only 10,925 in 1971. There has been a steady downward trend in annual expenditures per client both in actual and in "real" dollars. Data on number of clients served for 1973 and 1974 is not available because of problems in reporting. (9) Department of Social Services The effect of the tremendous increase in medical care costs in the past decade is most dramatically seen in the trend in medical assistance payments. The increase in expenditure reflects to a great extent, both the greater utilization, on the part of Medicaid clients, of nursing homes and health related facilities, and the increase in costs in "in-patient" care. The following table compares the trend in Medicaid expenditures and number of eligible clients. Total Medicaid Expend. Medicaid Payments Eligible Clients (Inc. Admin. Costs) To Vendors At End of Year Year Amount % Change Amount % Change No. % Change (in millions) over prevyr (in millions) over prev. yr. over prev. yr. 1968 $ 29.5 - $ 28.3 - 69,214 a) - 1969 35.2 +19.5% 33.8 +19.4% 66,357 a) - 4.1% 1970 39.6 +12.3 38.0 +12.4 78,479 +18.3 1971 60.1 +51.9 57.0 +50.0 79,709 + 1.6 1972 65.0 + 8.1 60.5 + 6.1 74,443 - 6.6 1973 70.9 + 9.1 66.5 + 9.9 65,769 -11.7 1974 83.8 +18.3 78.9 +18.6 61,581 - 6.4 a) estimated Despite a decreasing caseload between 1972 and 1974, costs continued to rise. Of the total Medicaid expenditures in 1974, 14% were for services provided by N.C.M.C., Plainview Division (N.C.M.C.), the Department of Health and the Department of Mental Health. While the County's cost of the Medicaid program is 25%, the revenue figures fluctuated greatly from year to year, presenting a somewhat unrealistic picture of trend in cost to County. GENERAL CONCLUSIONS In summary, the following generalizations can be made: the growth in County population was not a major factor in the upward trend in County expenditures for health services. a major cause of the increased expenditures for Personal Health Services were the increased costs for medical care services in the Medicaid program. (10) while there were new and expanded health programs in the County over the past 24 years, their impact on the overall trend in County expenditures for health was relatively small. the cost of medical care services in the County increased far in excess of the increases in the general Consumer Price Index for the New York area. net County costs for Personal Health Services increased sharply in recent years, despite the increased revenues from Federal and State agencies. The findings of this study support the recommendation that new measures for financing health care must take into account the inflationary effect that it can have on the public and private components of the health care system. It is essential that adequate controls and safeguards be built into any new system for comprehensive health insurance. TREND IN EXPENDITURES FOR PERSONAL HEALTH SERVICES Table I NASSAU COUNTY 1950-1974 12/75 Actual Dollars (in thousands) And Services Agency 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 HEALTH DEPARTMENT(excl. Env. Health) Total Expenditures $ 651 $ 1,805 $ 3,031 $ 3,107 $ 3,109 $ 3,892 $ 4,084 $ 4,320 $ 5,154 $ 5,834 $ 6,688 $6,904 Federal Revenue - - - - - 6 5 206 177 69 202 326 State Revenue 382 951 1,582 1,617 1,287 2,296 2,070 2,300 2,609 2,355 4,143 4,139 Departmental Revenue 1 16 73 72 243 334 337 532 728 788 760 730 Cost to County $ 268 $ 838 $ 1,376 $ 1,418 $ 1,579 $ 1,256 $ 1,672 $ 1,282 $ 1,640 $ 2,622 $ 1,583 $1,709 Services - Home Visits 69,962 91,257 97,911 97,934 101,433 97,562 70,578 77,327 79,582 62,786 49,641 52,370 Clinic Visits 18,015 30,000 43,352 45,689 47,379 40,968 46,602 59,386 74,767 66,516 65,839 70,323 Lab. Tests 102,636 333,420 419,130 436,224 437,926 452,343 401,867 262,466 275,466 279,660 319,579 328,808 MENTAL HEALTH Total Expenditures - $ 901 $ 2,521 $ 2,870 $ 4,604 $ 5,776 $ 5,947 $ 7,698 $ 8,492 $ 9,477 $ 11,651 $15,270 Federal Revenue - - - - - - - - - State Revenue - 418 1,173 1,350 2,103 2,608 2,599 3,355 3,812 4,228 4,912 5,668 Department/Agency Revenue - 327 727 808 1,204 1,556 1,891 2,539 2,494 3,015 4,039 6,141 Cost to County - $ 156 $ 621 $ 712 $ 1,298 $ 1,612 $ 1,457 $ 1,804 $ 2,186 $ 2,233 $ 2,700 $3,461 Services - Total Number of Visits - a) 71,183 74,498 76,700 79,490 105,219 107,724 115,218 128,882 173,777 176,500 SOCIAL SERVICES (Medicaid & Patterson Home) Total Expenditures - - - - $ 15,894 $ 35,113 $ 42,242 $ 47,265 70,809 $76,374 $ 83,769 $98,184 Federal Revenue 231650 - - - - 9,585 13,448 21,753 22,167 69,209 38,481 39,683 30,937 State Revenue - - - - 7,732 9,877 13,069 9,774 19,712 18,704 23,692 16,783 Departmental Revenue - - - - 1,721 924 - 1,000 1,415 1,737 1,914 1,921 Cost to County - - - - $- 3,144 $ 10,864 $ 7,420 $ 14,324 $ 19,527 $17,452 $ 18,480 $48,543 Services - Number Eligible for 22,032 Medical Assistance - - - - 88,885b) 69,214b 66,357b 78,479 79,709 74,443 65,769 61,581 Number of Patients in Patterson Home - - - - a) a) a) a) a) 800 800 800 NASSAU COUNTY MED. CNTR.(excl.Plainview) 6806 / 11175 , Total Expenditures 1760 12,078 . , 19.461 # # # , 13 613 16,056 22624 25,634 27,452 31,115 36,960 Federal Revenue - - - - 16 - 104 166 410 221 368 199 State Revenue 255 675 815 722 881 618 684 1,693 597 708 1,206 706 Departmental Revenue 406 2609 4,946 8,754 9019 11,6tb 12,751 15,623 19,573 20,391 20,4C9 25,157 Cost to County 1,099 3,522 5,414 2.602 3647 3.772 5,922 5,142 5,054 6,132 9.132 10,898 Services - Inpatient Days 171251 167,956 170,005 174.033 Clinic 161,330 150.928 }. 159.044 167.161 ? 31.017 78,375 75,630 132,886 161,692 Energency Room 132,757 143,126 143554 45,094 46,301 46.87 57,416 Total Weighted Patient Days b) 75,518 72861 70,600 68,577 209,531 205,656 200,887 232,682 234,107 213,395 224,403 232,156 PLAINVIEW DIVISION (N.C.M.C.) # 906 1,741 / 1,395 1,805 1,901 # 2,104 - 2.171 # 2,360 , 2.671 , 2501 , Total Expenditures 2.543 - 3.266 - Federal Revenue 81 11 87 63 25 66 145 53 37 64 55 309 State Revenue 152 270 Cepartmental Revenue 12 80 278 361 394 483 605 631 631 773 367 1249 1,508 1,464 1,536 1,680 Cost to County 1,632 1824 2029 1,806 1857 2,119 Services - Total Patient Days a) a) a) a) 48,774 35,933 22,651 23,361 20,949 16,781 16070 3.895 DRUG AND ALCOHOL ADDICTION Total Expenditures - - - - - - $ 520 Federal Revenue $ 1,192 $ 1,955 $ 3,660 $ 4,986 $ 8,186 - - - - - - State Revenue - 29 50 209 394 712 - - - - - - - Departmental Revenue 624 1,075 2,333 3,694 6,000 - - - - - - - Cost to County - - - - - - - - - - - Services - Clients Served $ 520 $ 539 $ 830 $ 1,118 $ 898 $ 1,474 - - - - - - 2,268 5,403 15,727 28,996 N.A. N.A ALL AGENCIES Total Expenditures $ 3,317 $10,907 $18,468 $ 19,860 Federal Revenue $ 39,121 $ 62,941 $ 74,425 $ 85,459 $114,715 $125,298 $140,752 $168,770 - - - - 9,601 State Revenue 13,454 21,862 22,568 69,846 662 38,980 40,647 2,110 32,174 3,651 3,760 12,090 Departmental/Agency Revenue 15,462 18,567 17,799 419 27,842 28,392 37,702 3,032 5,898 33,665 9,904 Cost to County 12,465 14,841 15,373 20,177 24,815 2,236 $ 5,765 26,562 $ 8,919 27,753 34,727 $ 6,196 $ 4,965 $ 19,184 $ 18,623 $ 24,915 $- 7,788 $ 31,364 $ 34,650$ 68,204 a) not reported b) Includes 1/3 clinic visits and 1/4 E.R. visits TREND IN EXPENDITURES FOR PERSONAL HEALTH SERVICES NASSAU COUNTY 1950-1974 12/75 Table II REAL DOLLARS (IN THOUSANDS) Agency 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 HEALTH DEPARTMENT(excl.Env. Health) Total Expenditures $ 914 $2,068 $3,214 $ 3,186 $ 3,109 3,731 $ 3,686 $ 3,630 $ 4,094 $ 4,440 $ 4,787 $ 4,460 Federal Revenue - - - - 6 $ 173 141 53 145 211 State Revenue 537 1,089 1,678 1,658 1,287 2,201 1,868 1,933 2,072 1,792 2,966 2,674 Departmental Revenue 1 18 77 74 243 320 304 447 578 600 S44 472 Cost to County $ 370 $ 960 $1,459 $ 1,454 $ 1,579 $ 1,204 1,509 $ 1,077 $ 1,303 $ 1,995 $ 1,132 $ 1,103 Services - Home Visits 69,962 91,257 97,911 97,934 101,433 97,562 70,578 77,327 79,582 62,786 49,641 52,370 Clinic Visits 18,015 30,000 43,352 25,089 47,379 40,968 46,602 59,386 74,767 66,516 65,839 70,323 Lab. Tests 102,636 333,420 419,130 436,224 437,926 452,343 401,867 262,466 275,466 279,660 319,579 328,808 MENTAL HEALTH Total Expenditures - $ 1,032 $ 2,673 $ 2,944 $ 4,604 $ 5,538 $ 5,367 $ 6,469 $ 6,745 $ 7,212 $ 8,340 $ 9,864 Federal Revenue - - - - - - - - - - State Revenue - 479 1,244 1,385 2,103 2,500 2,346 2,819 3,028 3,218 3,516 3,661 Departmental/Agency Revenue - 375 771 829 1,204 1,492 1,707 2,134 1,981 2,295 2,891 3,967 Cost to County - $ 179 $ 659 $ 730 $ 1,298 $ 1,546 $ 1,314 $ 1,516 $ 1,736 $ 1,699 $ 1,933 $ 2,236 Services - No. of Visits - - 71,183 74,498 76,700 79,490 105,219 107,724 115,218 128,882 173,777 176,500 SOCIAL SERVICES Total Expenditures - - - - $15,894 $33,675 $38,125 $39,718 $56,242 $58,123 $59,963 $63,426 Federal Revenue - - - - 9,585 12,894 19,633 18,628 54,971 29,285 28,406 19,985 State Revenue - - - - 7,732 9,470 11,795 8,213 15,657 14,234 16,959 10,842 Departmental Revenue - - - - 1,721 886 840 1,124 1,322 1,370 1,241 Cost to County - - - - $- 3,144 $10,416 $ 6,697 $12,037 $-15,510 $13,282 $13,228 $31,358 Services-# Elig. for Medical Assist. - - - - 88,885b) 69,214b) 66,357b) 78,479 79,709 74,443 65,769 61,581 # Patients in Patterson Home - - - - a) a) a) a) a) 800 800 800 NASSAU COUNTY MED. CNTR (excl.Plainview) Total Expenditures 472 , 2. 7.796 11,850 12.388 713,613 #15394 19,013 . "17,564 20,361 "20.892 $22,273 $ 23,876 Federal Revenue - - - - 16 - 94 134 326 163 263 129 State Revenue 358 773 864 740 881 593 617 1,722 474 539 863 456 Departmental Revenue 570 2,989 5245 8.918 9 019 11,185 11,508 13,128 15,546 15,518 14,609 16251 Cost to County 1544 , 4,034 , 5,741 2,645 3,697 , 3616 5'3'5 4.321 , 4,014 # Services Inpatient Days 4.667 / # 6537 7,040 171,251 167,956 170,005 174,033 Clinic 161,310 150,928 159,044 167,161 Emergency Room } }. } }. 81,017 78,315 75,630 132,886 161,692 132,757 143126 143554 45.094 46,301 Total Weighted Patient Days b) 46,687 57,416 75,518 72861 70,600 68577 209,531 205,656 206,887 232,682 234,107 213,345 224,403 232,156 PLAINVIEW DIVISION (N.C.M.C.) / # 1,598 , "1,850 # Total Expenditures 1,847 2,017 , # 1,272 1,901 1,954 1,987 2,121 1,903 1,820 2.110 Federal Revenue - - - - - - - - 1 - - - 1 State Revenue 35 76 86 73 87 10 131 45 30 49 40 238 Departmental Revenue 17 , 91 161 277 218 346 356 4.6 481 1,220 1.431 1.549 1502 1536 , 480 452 Cost to County 503 16" 1,472 1,533 1.611 1,374 # 1,329 : Services - Total Patient Days 1369 a) a) a) a) 48,774 35,483 22,651 23,361 20,949 16,781 16,070 8895 DRUG AND ALCOHOL ADDICTION Total Expenditures - - . - - - $ 469 $ 1,001 $ 1,553 $ 2,785 $ 3,569 $ 5,288 Federal Revenue - - - - - - - 24 40 159 282 460 State Revenue - - - - - - - 524 854 1,775 2,644 3,876 Departmental Revenue - - - - - - - - - - - - Cost to County - - - - - - $ 469 $ 453 $ 659 4 851 # 643 F 962 Services Clients Served - - - - - - 2,268 5,403 15,727 28,996 N.A. N.A ALL AGENCIES Total Expenditures 4,658 $12,494 $19,584 $20,368 $39,121 $ 60,355 $67,170 $71,812 $91,116 $95,355 $100,752 $109,024 Federal Revenue - - - - 9,601 12,900 19,732 18,964 55,478 29,665 29,096 20,785 State Revenue 930 2,417 3,872 3,856 12,090 14,824 16,757 14,956 22,115 21,607 26,988 21,747 Departmental / Agency Revenue 588 3,473 6,254 10,158 12,465 14,229 13,875 16,955 19,713 20,215 19,866 22,434 Cost to County $ 3,140 $ 6,604 9,458 $ 6,354 $ 4,965 $ 18,392 $16,806 $20,937 $-6,190 $23,869 $ 24,802 $ 44,058 a) not reported b) Includes 1/3 Clinic visits and 1/4 E.R. visits TREND IN EXPENDITURES FOR PERSONAL HEALTH SERVICES 12/75 Table III NASSAU COUNTY 1950-1974 INDEX OF REAL DOLLARS & SERVICES (1967 BASE YEAR) Agency 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 HEALTH DEPARTMENT (excl.Env.Health) Total Expenditures 29.4 66.5 103.4 102.5 100.0 120.0 118.6 116.8 131.7 142.8 154.0 1435 Federal Revenue - - - - - 100.0 a) 120.0 2,883.3 2,350.0 883.3 2,416.7 3,516.7 State Revenue 41.7 84.6 130.4 128.8 100.0 171.0 145.1 150.1 161.0 139.2 230.5 207.8 Department Revenue 0.4 7.4 31.7 30.5 100.0 131.7 125.1 184.0 237.9 246.9 223.9 194.2 Cost to County 23.8 60.8 92.4 92.1 100.0 76.3 95.6 68.2 82.5 126.3 71.7 69.9 Services - Home Visits 69.0 90.0 96.5 96.6 100.0 96.2 69.6 76.2 78.5 61.9 48.9 51.6 Clinic Visits 38.0 63.3 91.5 96.4 100.0 86.5 98.4 125.3 157.8 140.4 139.0 148.4 Lab. Tests 23.4 76.1 95.7 99.6 100.0 103.3 91.8 $9.9 62.9 63.9 73.0 75.1 MENTAL HEALTH Total Expenditures - 22.4 58.1 63.9 100.0 120.3 116.6 140.5 146.5 156.6 181.1 214.2 Federal Revenue - - - - - - - - - - State Revenue - 22.8 59.2 65.9 100.0 118.9 111.6 134.0 144.0 153.0 167.2 174.1 Department/Agency Revenue - 31.1 64.0 68.9 100.0 123.9 141.8 177.2 164.5 190.6 240.1 329.5 Cost to County - 13.8 50.8 56.2 100.0 119.1 101.2 116.8 133.7 130.9 148.9 172.3 Services - Number of Visits - - 92.8 97.1 100.0 103.6 137.2 140.4 150.2 168.0 226.6 230.1 SOCIAL SERVICES Total Expenditures - - - - 100.0 211.9 239.9 249.9 353.9 365.7 377.3 399.1 Federal Revenue - - - - 100.0 134.5 204.8 194.3 573.5 305.5 296.4 208.5 State Revenue - - - - 100.0 122.5 152.5 106.2 202.5 184.1 219.3 140.2 Department Revenue - - - , 100.0 51.5 - 48.8 65.3 76.8 79.6 72.1 Cost to County - - - - b) b) b) b) b) b) b) b) Services-! Elig. for Medical Assis. - - - - 100.0 77.9 74.7 88.3 89.7 83.8 74.0 69.3 # Patients in Patterson Home - - - - f) f) f) f) f) b) b) b) NASSAU COUNTY MED. NTR.(excl.Plainview) Total Expenditures 18.2 57.3 370 91.0 100.0 113.1 1290 134.7 149.6 153.5 163.6 175.4 Federal Revenue - - - - 1000 - 587.5 868.8 2037.5 1,0590 16438 806.3 State Revenue 40.6 87.7 98.1 84.0 100.0 673 70.0 161.4 53.8 1.61.2 98.0 51.8 Departmental Revenue 6.3 33.1 58.2 99.5 1000 1240 127.6 145.6 172.4 172.1 1620 180.2 Cost to County 41.8 109.1 155.3 72.2 1000 97.8 144.6 116.9 1086 126.2 176.8 190.4 Services - Inpatient Days 1000 98.1 99.3 101.6 94.2 88.1 92.9 Clinic 97.6 f Emergency Room } } f } 1000 96.7 93.4 1640 199.6 163.9 176.7 177.2 1000 102.7 1035 127.3 167.5 161.6 156.6 152.1 Total Weighted Patient Days e) 1000 98.2 98.7 111.0 111.7 101.8 107.1 110.8 PLAINVIEW DIVISION (N.C.M.C.) Total Expenditures 66.9 84.1 97.2 97.3 1000 106.1 103.1 104.3 111.6 100.1 95.7 111.0 Federal Revenue. - - - - - - - I - - - - State Revenue 40.2 87.4. 98.9 839 1000 69.0 150.6 51.7 34.5 56.3 46.0 273.6 Departmental Revenue 6.1 32.7 57.9 99.6 1000 124.5 128.1 146.0 1730 1727 162,6 180.9 Cost to County 79.4 93.2 104.1 97.8 1000 1049 95.8 99.8 104.9 89.5 86.5 54.1 Services - Total Patient Days f) f) f) f) 1000 73.8 464 47.9 43.0 34.4 32.9 18.2 DRUG AND ALCOHOL ADDICTION Total Expenditure - - - - - 213.6 331.1 593.8 761.0 - 100.0 c) 1,127.5 Federal Revenue - - - - - - - 100.0 d) 166.7 662.5 ,175.0 1,916.7 State Revenue - - - - - - - 100.0 d) 163.0 338.7 504.6 739.7 Department Revenue - - - - - - - - - - - Cost to County - - - - - - 100.0 c) 96.6 140.5 181.7 137.1 203.0 Services - Clients Served - - - - - - 100.0 c) 238.2 693.4 1,278.5 - - ALL AGENCIES Total Expenditures 11.9 31.9 50.1 52.1 100.0 154.3 171.7 183.6 232.9 243.7 257.5 278.7 Federal Revenue - - - - 100.0 134.4 205.5 197.5 577.8 309.0 303.1 216.5 State Revenue 7.7 20.0 32.0 31.9 100.0 122.6 138.6 123.7 182.9 178.7 223.2 179.9 Department/ Agency Revenue 4.7 27.9 50.2 81.5 100.0 114.2 111.3 136.0 158.1 162.2 159.4 180.0 Cost to County 63.2 133.0 190.5 128.0 100.0 370.4 338.5 421.7 0 480.7 499.5 887.4 a) 1968 = Base year b) Index not-computed; year to which revenues apply is questionable or not reported. c) 1969 = Base year d) 1970 . Base year c) Includes 1/3 Clinic visits and 1/4 E.R. visits f) Not reported NASSAU COUNTY MEDICAL CENTER Table IV ACTUAL DOLLARS (in thousands) AND SERVICES 1950 - 1974 Item 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 EXPENDITURES Administration 4 $ 513 $ H $ $ $ 118 939 # 1,112 $ $ à 948 1,213 1,384 1,566 1,881 2,091 2,384 3,036 Buildings 337 1,322 2,041 2,057 2,107 2397 2,667 3,397 3,598 3.916 4,786 6,893 Patients In-Patients 1,305 4.971 8,195 7,349 8,235 9,787 11,558 13,070 12.677 15,226 17,215 20,001 Clinics & E.R. - - - 1,724 2,058 2,760 3852 4,591 7,478 6,219 6,730 7,030 TOTAL EXPENDITURES # # $ * $ 1,760 6,806 11,175 12078 13,613 16,056 19,461 22,624 25,634 27,452 31,115 36,960 REVENUES Departmental Revenue Total $ 406 # 2,609 # 4.946 $ 8,754 $ 9019 12,751 # 19.573 4 116666 15,623 20,391 20,409 25,157 Medicaid 293 1,879 2,798 5,580 5,826 5,456 7,805 9,007 9,206 Medicare 7,332 7401 8669 - - - - 3,440 Other 113 2,265 3,471 4528 730 5,835 4749 7,269 1,088 2,170 2,850 2.121 2.601 3,541 3,506 3,331 4,136 Blue Cross - - 1,060 1,004 928 1,484 1,734 2,150 2,835 3,245 3,322 4,546 Federal Revenue - - - - 16 - 104 166 410 221 368 199 State Revenue 255 675 815 722 881 618 684 1,693 597 708 1,206 706 TOTAL REVENUE # 661 # 3,284 5,761 # # 4 9,476 $ 4 9,916 $ 12,284 13539 17,482 20,580 21,320 21983 26,062 NET COST TO COUNTY $ $ $ # $ $ 1099 3,522 5,414 2.602 3,697 3,772 5,922 5,142 5,054 6,132 9,132 10,898 SERVICES Inpatient Days } }a }a 171,251 167,956 170,005 174,033 166330 150,928 159,044 167,161 Clinic a a a 81,017 78,375 75,630 132,886 161,692 132,757 143,126 143,554 Emergency Room 45,094 46,301 46,687 57,416 75,518 72,861 70,600 68,577 Total Weighted Patient Days c) 209,531 205,656 206,887 232,682 234,107 213,395 224,403 232,156 RATIO TO POPULATION Ratio Inpatient Days Per - - - - 121.3 118.4 119.4 121.9 1,000 Population 112,9 105.5 111.1 116.8 Ratio Clinic Visits Per - - - - 57.4 55.3 53.1 1,000 Population 93.1 113,2 92.8 100.0 100.3 Ratio Emerg. Rm. Visits Per - - - - 31.9 32.7 32.8 40.2 52.8 51,0 49,3 47,9 1,000 Population Ratio Weighted Patient Days - - - - Per 1,000 Population 148.4 145,0 145.3 162.9 163.8 149.2 156.8 162,2 a) Not Reported b) Estimated c) Includes 1/3 Clinic Visits and 1/4 E.R. visits PLAINVIEW DIVISION ( NASSAU COUNTY MEDICAL CENTER) TableIV A ACTUAL DOLLARS (in thousands) AND SERVICES 1967 - 1974 Item 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 EXPENDITURES # # * # 131 to 134 it 137 $ 154 a 154 11 135 132 229 63 H 104 N 145 # 161 Administration Buildings 226 303 377 414 450 508 571 609 690 994 378 391 Patients 988 1,150 846 1,074 1,192 1,270 1233 1,466 1,249 1,514 Inpatients 617 1,219 Clinics & E.R. - - - 142 503 484 398 448 730 272 450 529 TOTAL EXPENDITURES a 906 1,741 2,104 # 1,395 1,805 1,901 2,171 2,360 2,671 2,501 2,543 3,266 REVENUES 483 or & 631 # # # # & 778 Departmental Revenue Total 12 80 152 270 # 278 361 Sr 394 a 605 at 631 Medicaid 9 58 111 197 203 263 288 371 338 254 305 376 Medicare - - - - 112 168 - - 106 267 377 162 Other 3 22 41 73 75 98 - - 113 - 169 - Blue Cross - - - - - - - - $ - 45 71 Federal Revenue - - - - - - - I - 1 - State Revenue 25 66 81 71 87 63 145 53 37 64 55 369 TOTAL REVENUE 4 # 146 8 233 $ 37 341 365 # 424 w $ 539 536 of 642 695 $ 686 St 1,147 NET COST TO COUNTY $ $ 1,249 $ 1,508 % & 869 1,464 # 1,824 X 1,536 # 1,680 1,632 2029 1,806 1,857 # 2,119 SERVICES Patient Days a) a) a) a) 48,774 35,983 22,651 23,361 20,949 16,781 16,070 8,895 RATIO TO POPULATION Ratio Patient Days Per - - - - 34.5 25.4 15.9 16.4 14.7 11.7 11.2 6.2 1,000 Population a) Not reported NASSAU COUNTY DEPARTMENT OF SOCIAL SERVICES (Medicaid & Holly Patterson Home) 12/75 Table V ACTUAL DOLLARS (in thousands) AND SERVICES 1967 - 1974 Item 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 EXPENDITURES Medical Assistance Med.Assist.Prog.-Admin.Costs - - - - $ 537 a) $ 1,187a) $ 1,428a) $ 1,582 $ 3,119 $ 4,442 $ 4,316 $ 4,974 Medical Assistance Paymts. Physician's Services - - - - - 3,777 6,040 3,637 5,075 5,025 5,763 6,321 Dental Care - - - - - 3,913 3,905 1,293 2,193 1,857 1,778 2,076 Other Practioner's Serv. - - - - - - - 275 971 890 964 990 Hospital Care - - - - - 10,200 9,713 12,223 18,123 17,948 17,366 18,829 Clinic Care - - - - - 330 677 1,286 3,248 4,118 4,425 5,370 Home Aid Services , - - - - 661 912 1,472 2,559 3,396 4,404 5,035 Home Nursing Services - - - - - 86 96 238 321 278 279 322 Drugs/Sick Room Supplies - - - - - 2,368 2,104 3,014 4,255 4,183 4,324 4,889 Prosthetic Appliances& Eye glasses - I - / - 467 305 356 592 635 645 603 Phys. Therapy RRS - - - - - 60 93 45 90 81 101 170 Nursing Home Care 1 - - - - 5,691 9,506 13,850 18,227 19,742 21,382 27,072 Other - - - - - 763 766 309 1,332 1,133 1,403 1,554 Health Related Facilities I - I I - - I I I 1,235 3,715 5,644 Total Med. Asst. (Payments & Admin) - - I - (15,894 b) 29,503 35,245 39,580 60,105 64,963 70,865 83,849 Patterson Home - - - - 5,610 6,997 7,685 10,704 11,411 12,904 14,335 TOTAL EXPENDITURES I I - I $15,894 $35,113 $42,242 $ 47,265 $ 70,809 $76,374 $83,769 $98,184 REVENUES Federal Revenue - $ - I $ 9,585 $13,448 $21,753 $ 22,167 $ 69,209 $38,481 $39,683 $30,937 State Revenue , I I 1 7,732 9,877 13,069 9,774 19,712 18,704 23,692 16,783 Departmental Revenue 1 I - I 1,721 924 - 1,000 1,415 1,737 1,914 1,921 TOTAL REVENUE - - - I $19,038 $24,249 $34,822 $ 32,941 $ 90,336 $58,922 $65,289 $49,641 NET COST TO COUNTY I 1 - 1 $-3,144 $10,864 $ 7,420 $ 14,324 $-19,527 $17,452 $18,480 $48,543 SERVICES Total # Elig. for Med. Assist - , - - 88,885c) 69,214c) 66,357c) 78,479 79,709 74,443 65,769 61,581 # Patients in Patterson Home - - - - I I I - - 800 800 800 RATIO TO POPULATION Ratio total Eligible for Med. Asst. to 1,000 pop. - I - - 62.9 48.8 46.6 55.0 55.8 52.1 46.0 43.0 Ratio # Patients in Patter. Home to 1,000 population 0.6 0.6 0.6 Ratio # Pts. in Patt.Home to 1,000 Pop. (over 65 yrs) 1 I I - I I - 1 - 6.7 6.6 6.4 a) Data not available; estimates based on % administrative costs in 1970 b) Breakdown not available for 1967 c) estimated Table VI NASSAU COUNTY DEPARTMENT OF HEALTH (Personal Health Services) ACTUAL DOLLARS (in thousands) AND SERVICES 12/75 1950 - 1974 Item 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 EXPENDITURES (Excl. Env. Health) Home Health $ 253 $ 581 $ 898 $1,008 $ 1,109 $ 1,227 $ 1,216 $ 1,199 $ 1,324 $ 1,343 $ 1,469 $ 1,779 Clinic 60 225 346 371 403 496 623 856 1,331 1,667 1,820 2,025 Other Personal Health 181 388 736 710 600 958 1,002 1,157 1,170 1,469 1,853 1,359 Lab Services 95 419 583 564 558 716 751 596 631 617 718 787 Admin. Services 62 192 468 454 439 495 492 512 698 738 828 954 TOTAL EXPENDITURES $ 651 $1,805 $3,031 $3,107 $ 3,109 $ 3,892 $ 4,084 $ 4,320 $ 5,154 $ 5,834 $ 6,688 $ 6,904 REVENUES (Excl. Env. Health) Federal a) - - - - - $ 6 $ 5 $ 206 $ 177 $ 69 $ 202 $ 326 Departmental Total $ 1 $ 16 $ 73 $ 72 $ 243 334 337 532 728 788 760 730 Medicaid - - - - 18 65 46 84 342 393 335 343 Medicare - - - b) 137 194 132 105 119 121 114 167 Other 1 16 73 72 88 75 159 343 267 274 311 220 State Aid 382 951 1,582 1,617 1,287 2,296 2,070 2,300 2,609 2,355 4,143 4,139 TOTAL REVENUE $ 383 $ 967 $1,655 $1,689 $ 1,530 $ 2,636 $ 2,412 $ 3,038 $ 3,514 $ 3,212 $ 5,105 $ 5,195 NET COST TO COUNTY (Excl. Env. Health) $ 268 $ 839 $1,376 $1,418 $ 1,579 $ 1,256 $ 1,672 $ 1,282 $ 1,640 $ 2,622 $ 1,583 $ 1,709 SERVICES Home Visits - Nursing & Therapy 69,962 91,257 97,911 97,934 101,433 97,562 70,578 77,327 79,582 62,786 49,641 52,370 Clinic Visits 18,015 30,000 43,352 45,689 47,379 40,968 46,602 59,386 74,767 66,516 65,839 70,323 Lab Tests Performed 102,636 333,420 419,130 436,224 437,926 452,343 401,867 262,466 275,466 279,660 319,579 328,808 RATIO TO POPULATION Ratio Home Visits to 1,000 Population 104.0 69.8 69.9 69.7 71.8 68.8 49.6 54.2 55.7 43.9 34.7 36.6 Ratio Clinic Visits to 1,000 Population 26.7 22.9 31.0 32.5 33.6 28.9 32.7 41.6 52.3 46.5 46.0 49.1 Ratio Lab Tests to 1,000 Population 152.6 254.9 299.4 310.3 310.1 319.0 282.2 183.8 192.8 195.6 223.3 229.8 a) Primarily Medicare b) Less than $500 Table VII NASSAU COUNTY DEPARTMENT OF MENTAL HEALTH 12/75 ACTUAL DOLLARS (in thousands) AND SERVICES 1960 - 1974 Item 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 EXPENDITURES Administration - $ 68 $ 76 $ 109 $ 972 $ 1,412 $ 180 $ 233 $ 260 $ 241 $ 280 $ 346 Direct Services - 1 293 309 328 366 398 517 611 531 511 589 Contract Agencies - 832 2,152 2,460 3,304 3,998 5,369 6,948 7,621 8,705 10,860 14,335 TOTAL EXPENDITURES - $ 901 $2,521 $2,878 $4,604 $ 5,776 $5,947 $7,698 $8,492 $9,477 $11,651 $15,270 REVENUES County Services Fees - - $ 2 $ 2 $ 2 $ 3 $ 11 $ 13 $ 14 $ 26 $ 14 $ 20 Medicare - - - - - - - - - - - - Medicaid - - 5 5 5 6 23 26 29 53 28 42 Contractual Services Fees - $ 42 107 110 226 317 412 547 671 631 748 687 Medicare - - - - - - - - - - 298 21 Medicaid - - - -- 44 62 80 107 205 437 701 1,901 3rd Party - - - - - - - - 231 57 9 64 Sales of Products - 17 43 45 85 119 155 206 76 350 494 797 Grants - 26 67 69 137 192 250 332 547 881 1,034 1,029 Other - 32 84 86 174 244 317 420 189 347 570 1,430 State Revenue - 392 1,106 1,281 1,966 2,416 2,349 3,023 3,265 3,347 3,878 4,639 Agency Contribution - 236 486 560 668 805 893 1,220 1,079 1,114 1,177 1,179 NET COST TO COUNTY - $ 156 $ 620 $ 721 $1,298 $ 1,611 $1,456 $1,804 $2,186 $2,233 $ 2,701 $ 3,460 SERVICES Direct Service Interviews - a) 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 Contractual Interviews - a) 66,183 69,498 71,700 74,490 100,269 102,724 110,218 123,882 168,777 171,000 Total Interviews 71,183 74,498 76,700 79,490 105,269 107,724 115,218 128,882 173,777 176,000 RATIO TO POPULATION - Ratio Dir. Serv. Interview to 1,000 population - a) 3.6 3.6 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 Ratio Contractual Interviews to 1,000 population - a) 47.3 49.4 50.8 52.5 70.4 71.9 77.1 86.6 117.9 119.5 Ratio total interviews to 1,000 population - a) 50.9 53.0 54.3 56.0 73.9 75.4 80.6 90.1 121.4 123.0 a) not reported NASSAU COUNTY DEPARTMENT OF DRUG & ALCOHOL ADDICTION Table VIII ACTUAL DOLLARS (in thousands) AND SERVICES 12/75 1969 - 1974 Item 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 EXPENDITURES TOTAL EXPENDITURES - - - - - - $ 520 $ 1,192 $ 1,955 $ 3,660 $ 4,986 $ 8,186 REVENUES Federal Revenue - - - - - - - $ 29 $ 50 $ 209 $ 394 $ 712 State Revenue - - - - - - - 624 1,075 2,333 3,694 6,000 TOTAL REVENUE - - - - - - - $ 653 $ 1,125 $ 2,542 $ 4,088 $ 6,712 NET COST TO COUNTY - - - - - - $ 520 $ 539 $ 830 $ 1,119 $ 898 $ 1,473 SERVICES Direct Service Clients - - - - - - 2,268 4,610 4,802 3,996 - - Sub Contract Agencies - - - - - - - 793 10,925 25,000 - - TOTAL SERVICES - I - - - - 2,268 5,403 15,727 28,996 - - RATIO TO POPULATION Ratio Direct Service Clients to 1,000 population - - - - - - 1.6 3.2 3.4 2.8 N.A. N.A. Ratio Sub Contract Agencies to 1,000 population - I I - - - - 0.6 7.6 17.5 N.A. N.A. Ratio Total Clients to 1,000 Pop. - I - 1 - - 1.6 3.8 11.0 20.3 N.A. N.A. CHART I ALL AGENCIES TOTAL ENPENDITURES NET COST TO COUNTY Real DOllARS a) 1950-1974 Real DOLLARS (in thousands) # 110,000 TOTAL 105000. EXPeNditures 102000 99.00 96.00 83100 90000 87000 34000 81000 78000 75000 72000 69000 66000 63000 60000 57000 54000 51000 48000 45000 COST TO 42000 county 39000 30000 33,000 3acco 27000 24000 22000 18000 15000 120.00 9000 6000 3000 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 a> Based on Consumer Price Index for N.Y arca. - Base year= 1967 (-6190) F CHARTII NASSAU COUNTY MEDICAL CENTER (evcl. Plainview DIVISION) TOTAL EXPENDITURES & NET COST TO COUNTY ReAL DOLLARS a) 1950-1974 Real Dolbis (in thousa ds) 26,400 TOTAL 25,200 EXPENDITURES 24,000 22,800 21,tco 20,400 19,200 18000 16,800 15,600 14,400 13,200 12,000 10800 9600 8400 COST TO 7200 County 6000 4800 3600 + 2400 1200 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 a> Based on Consumer Price Index for NY area- Base Year= 1967 PLAINVIEW DIVISION (NASSAU COUNTY MED, CNTR.) CHART II A TOTAL EXPENDITURES NET COST TO COUNTY REAL DOLLARS a> 1950-1974 Real Dollars Cin thousands) 2,500 ToTal 2,000 Expenditures 1,500 NET COST TO COUNTY 1,000 500 1950 ,960 1905 1966 1967 1968 1969 1970 1971 1972 1973 1974 a) Based on Consumer Price Index foR N.Y.ARea . Base YeaR = 1967 a CHART III NASSAU COUNTY DEPARTMENT OF SOCIAL SERVICES TOTAL EXPENDITURES + NET COST TO COUNTY in Real Dollars a> 1967-1974 Real Dollars (in thousands) TOTAL EXPENDITURES # 60,000 55,000 50,000 45,000 40,000 35,000 COST TO 30,000 COUNTY 25000 20,000 15000 10000 5000 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 -a> Based on Consamer Price Index for n.y. area- Base year 167 (15,510) 1 CHART IV NASSAU COUNTY DEPARTMENT OF HEALTH TOTAL EXPENDITURES AND NET 1950-1974 COST TO COUNTY (in Real Dollars) a> REAL DOLLARS (in thousands) 4 4800 4600 TOTAL EXPENDITURES 4400 4200 4000 3800 3600 3400 3200 3000 2800 2600 2400 2200 2000 1800 1000 NET COST 1400 TO COUNTY 1200 1000 800 600 400 200 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 a> Based on Consumer Price Index for N.Y. area - Base year = 1967 CHARTI NASSAU COUNTY DEPARTMENT OF MENTAL HEALTH TOTAL EXPENDITURES + NET COST TO COUNTY III REAL DOLLARS a) 1960-1974 REAL DOLLARS (in thousands) 10.100 9900 TOTAL Expenditures 9600 9:300 4100 8700 8400 8100 7800 7500 7200 6900 6600 6300 6010 5700 5400 5100 4800 4500 4200 3900 3000 3300 3000 2700 2400 COST TO 2100 COUNTY 1800 1500 1200 900 600 300 1950 1960 1915 1966 1967 1968 1969 1970 1971 1972 1973 1974 a> Based on Consumer Price Index for MY area - Base year= M67 F: CHARTII NASSAU COUNTY DEPARTMENT OF DRUG + ALCOHOL ADDICTION TOTAL EXPENDITURES + NET COST TO COUNTY REAL DOLLARS 9> 1969-1974 Real Dollars (in thousands) $ 5400 5250 TOTAL 5100 EXPeNdituRes 4950 4800 4650 4500 4350 4200 4050 3900 3750 3600 3450 3300 3150 3000 2850 2700 2550 2400 2250 2100 1950 1800 1650 1500 1350 1200 1050 900 COST TO COUNTY 750 600 45C 300 150 1950 1960 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 as Based on Consumer Price Index for NY. area Base year = 1967 APPENDIX A NASSAU COUNTY DEPARTMENT OF HEALTH CONSUMER PRICE INDEX N.Y. Area U.S. 1950 71.2 72.1 1960 87.3 88.7 1965 94.3 94.5 1966 97.5 97.2 1967 100.0 100.0 - Base Year 1968 104.3 104.2 1969 110.8 109.8 1970 119.0 116.3 1971 125.9 121.3 1972 131.4 125.3 1973 139.7 133.1 1974 154.8 147.7 1975* 167.5 162.8 * Through August 1975 Source - Bureau of Labor Statistics APPENDIX B NASSAU COUNTY POPULATION BY AGE GROUP 1950, 1960, 1965 - 1975 <20 20-64 65+ Total 1950 218,759 413,702 40,304 672,765 1960 529,000 698,000 81,000 1,308,000 1965 575,700 737,200 87,100 1,400,000 1966 570,100 743,800 92,100 1,406,000 1967 564,500 750,300 97,200 1,412,000 1968 558,800 757,000 102,200 1,418,000 1969 553,100 763,600 107,300 1,424,000 1970 547,283 768,451 112,341 1,428,075 1971 531,310 782,224 115,466 1,429,000 1972 515,280 796,080 118,640 1,430,000 1973 499,370 809,830 121,800 1,431,000 1974 483,031 823,136 124,833 1,431,000 1975 467,080 836,940 127,980 1,432,000 Sources: 1950, 1960, 1970 - U.S. Census 1975 - Nassau County Planning Department estimates Remainder - Nassau County Department of Health's Biostatistics Section estimates.