Health agency assesses budget

Restructuring could include staggered work hours to cut spending costs

Consolidation and restructuring of some functions and staggered work hours are among options being considered to slice more than $4.4 million from the state Health Department's budget, said state health Director Dr. Chiyome Fukino.

All division chiefs are looking at expenses and possible cuts, she said in an interview, "but we have to consider whatever cuts will be made are potentially permanent."

The governor has asked all departments to reduce spending by 4 percent because of an economic slump and projected shortfall in state revenues.

Many budget cuts were made during a similar economic downturn in the 1990s and some divisions never recovered from them, Fukino said, explaining the department is trying to avoid long-term repercussions.

She said the department can't adopt a four-day work week because of its public service responsibilities, but the staff is looking at how work hours can be staggered.

"It's not just about saving money from electricity use but how can we help our employees and families," she said. "There are issues with the cost of gas. If we can help in that regard, it is a benefit to the community as a whole."

For example, she said, shifts possibly could be staggered in the community health centers to provide full coverage without employees having to be on call after hours.

The Legislature appropriated $454,551,367 in general funds for the department for 2008-2009. The governor's restriction leaves $450,116,018.

More cuts also may be needed as a result of the Council of Revenues' latest downward revision of projected state revenues, Fukino said.

The Council is a group of local economists that projects the state's tax intake.

The Health Department has programs and services that are beneficial and "nice to have," she said. "The question we have to ask now is whether that is a true public health function, whether it is absolutely necessary."

She said discussions have been held with the governor and the Hawaii Government Employees Association about structural changes proposed for the Behavioral Health Administration, including the Adult Mental Health Division, Child and Adolescent Mental Health Division and Developmental Disabilities Division.

They receive the bulk of the DOH's general fund expenditures, Fukino said, pointing out, "all came out of court oversight during this administration."

The three divisions were ordered to improve services to clients in settlements of lawsuits.

She said the department is proposing to consolidate certain functions and contract out other functions relating to fiscal management. "We're trying to focus on quality patient care. When the systems were under court oversight, it was 'you build it right away, no matter what it costs.'

"Now we have to look at how we build sustainable quality care for our consumers."

She said a lot of people think it was "a capricious decision " when the department closed down Assertive Community Treatment teams treating the seriously mentally ill and shifted patients to community-based case management programs.

But the decision was based on information collected over a long period of time about how the teams were working, she said.

Contracting out billing will allow the department to seek maximum federal dollars and free staff to monitor contracts better, talk to clients and see if services are doing what they're supposed to do, she said.