By Steve Key
Hoosier State Press Association

The Indiana Hospital Association wants the state Board of Accounts to remove the salaries of doctors working for county hospitals from a database of public employees.

The list is a record the public can tap to see what individual public employees and officials are paid.

The hospital association points out that county hospitals are self-sufficient entities that don’t receive tax dollars.

Officials say public access to salary information puts county hospitals at a competitive disadvantage to private hospitals in the retention and recruitment of physicians.

I understand that point of view, but the fact remains that leadership of county hospitals is tied to county government.

The assets of the county hospital belong to taxpayers. The fiscal health of a county hospital has implications for the health of their communities and the economic strength of those communities.

County commissioners appoint the boards that operate county hospitals. Those decisions can have a dramatic impact on the provision of health care and the ability of county hospitals to compete with neighboring private hospitals.

Those boards make decisions on the building of new wings and the purchase of new diagnostic and treatment equipment.

The boards approve strategic planning concerning the hiring and level of financial support for new general practice doctors and where those doctors’ offices will be located within the hospital’s geographic sphere of influence.

Those doctors feed patients into the hospital.

The boards also make decisions on specialty areas of medicine, including preventive and surgical.

All of these decisions build a hospital’s reputation in a competitive health care market.

Savvy Hoosiers make conscious decisions about who they want to treat their heart ailment or sports injury.

So while county hospitals may be in a position where they don’t need to spend tax dollars, the tie between county government and those hospitals is strong, and citizens have a vested interest in the operation of those hospitals.

So what does that have to do with public knowledge of doctors’ compensation?

In a period of competition between hospitals, public and private, and an era where rural hospitals struggle to attract needed physicians to care for citizens and maintain a county hospital’s bottom line, what physicians are paid is relevant.

Is the struggle to lure young physicians a factor of salary offered, rather than rural location? Does the county hospital need to over-compensate for the lack of cultural amenities with a higher salary offer?

The ability for the public to make comparisons between their county hospital and similarly situated rural county hospitals may point to a leadership issue with the board.

The inability to hire particular specialists may push county residents to take the longer drive outside the county for medical care. Not only is this an inconvenience to county residents, but in the long run it may damage the financial viability of the county hospital.

A financially weak county hospital not only can impact the level of health care for that county, but it can impact the local economy.

County hospitals are often one of the largest employers in a county. If the hospital isn’t doing well financially, there can be a ripple effect for the community.

And if the reputation of the county hospital is poor, it could play a role in the decision of companies looking to choose where to build a new manufacturing plant or other industry.

So while I understand the competitive concern of county hospitals, I vote for continued access to data that offers a window into the effectiveness of county hospital leadership.

It’s directly linked to the leadership of elected county officials.

Steve Key is executive director and general counsel for HSPA.

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