County’s Role in the Community  
  
The County is the largest provider of indigent healthcare services in the County and is mandated to provide those services pursuant to state law. The Pittsburg Health Clinic has expanded to become the largest clinic in the County health system with an average of 8,613 medical outpatient visits per month, which equates to well over 100,000 visits per year in fiscal year 2016/17. Services range from primary adult and pediatric care to specialty services, which include audiology, orthopedics, podiatry and dental care services. On a regional basis, patient visits at the Pittsburg Health Clinic account for 65% of all County-operated clinic visits in the East Contra Costa County.[5]  
  
The role of counties as the mandated providers of indigent healthcare has evolved since the 1945 adoption of the Local Hospital District Law (now the Local Health Care District Law[6]), which originally provided for the establishment of community hospitals in California. In Contra Costa County, there have primarily been three healthcare districts providing some level of health services. Each was established in 1948 following the passage of the local hospital district law. Those healthcare districts are: Of these three Districts, two have filed for bankruptcy (Los Medanos and West Contra Costa) and one has been reorganized and made a subsidiary district to a city (Mount Diablo). In all cases, none currently provides direct healthcare services or operates a community hospital.  
  
Part of the reason healthcare districts have struggled is because hospital and healthcare finance, generally, has evolved into a very complex system. The majority of County residents accessing health care use government-subsidized health plans. For illustrative purposes, a 2015 study commissioned by the County noted that the “payer mix” for healthcare costs in Contra Costa County in 2014 was approximately 70% Government Payer (Medicare and MediCal) and 30% Private Payer (commercial health coverage and private payer)[8].  
  
Typically, government payer health plans (i.e. Medicare and MediCal) do not cover the full cost of providing services. Geographically, this imbalance is more pronounced in specific regions. As a result, the County health system is best poised to provide indigent healthcare services and is in the best position to be able to achieve economies of scale in its approach to deployment of those services into the community. The County’s capabilities are further evidenced by the fact that, following the bankruptcies and subsequent closures of the hospitals operated by the Los Medanos and West Contra Costa Healthcare Districts, the County was able to accommodate the healthcare needs of the populations within those Districts. It is important to note that non-County operated hospitals in surrounding areas also played a critical role in providing services to those residents as well.  
  
Proposal for Dissolution  
  
The County will request that the dissolution of the District be taken pursuant to Government Code section 56654, which authorizes the legislative body of an affected local agency to propose a change of organization by adopting a resolution of application.   
  
The County will further request that, under the Contra Costa Local Agency Formation Commission’s (LAFCO) conditioning powers under Government Code section 56886, the dissolution of the District be subject to the following terms and conditions: All of the assets, rights and responsibilities of the District are to be transferred to the County as the successor to the District.  
  
This proposal is consistent with the spirit of the Little Hoover Commission report findings released in August 2017, that of prior grand juries and similar to a dissolution governance option presented to LAFCO in its 2007 Healthcare District Municipal Services Review (MSR). Ultimately, this request is in the best interest of the residents served in the East County area and the most efficient use of both taxpayer dollars and publically-owned infrastructure.