Mention Metro and most people think of transportation and land-use planning. Or maybe solid waste. Metro is, after all, the governmental authority set up to deal with regional issues.
But the governmental body has decided to take a look at an issue far from what it normally deals with - the political hot potato of health care.
Next month, Metro's staff will present to commissioners a report on the feasibility of the regional authority getting involved in health care, including possibly having the authority to prohibit hospital expansion plans that don't meet what Metro perceives as community needs. Hospital officials aren't exactly thrilled at the prospect.
The upcoming report was authorized by an April resolution passed by Metro commissioners. That resolution was the result of a campaign undertaken by a number of area organizations, most prominently Local 49 of the Service Employees International Union.
Union representatives and their allies say the community should have a voice in health care planning, including where new hospitals are sited and what services they provide. And they think Metro could be the body to represent the public's interest in those decisions.
Ellen Pinney, executive director of Oregon Health Action Campaign, a Salem-based coalition of organizations working on health care issues, said Metro might be the only governmental body capable of forwarding the public's interest in health care decisions.
'There is no system now,' Pinney said. 'It seems to those of us involved that decisions are made without any kind of community input at all. I don't see any other logical player that has the mandate Metro does to address the needs of the community.'
Government and hospitals already experience an interdependent relationship. Most hospitals are private enterprises, but because most Portland-area hospitals also fall under nonprofit status, they realize tax benefits and are responsible for a nonprofit mission to the community. Oregon Health and Science University is often referred to as a quasi-public institution and does receive state funding. And through Medicare and Medicaid, tax dollars pay a large percentage of the bills at all hospitals in the state.
Activists such as Pinney think the public should have a voice in what services hospitals offer. 'Decisions about where to spend millions of dollars are being made on the basis of enhancing market share as opposed to being made with an eye to whether or not those decisions meet community health needs,' Pinney said.
Pinney said she would like to see area hospitals spend less money on hospital expansion and more for primary care for the uninsured.
'You can look at cranes in front of every major hospital system and question, in a community like Portland, where no hospital is operating at capacity, whether or not it is appropriate to be investing money in new wings and new facilities while people cannot get access to primary health care,' Pinney said.
But Bruce Bishop, a Salem lawyer who is a lobbyist for the Oregon Association of Hospitals and Health Systems, said that if Metro became involved in approving where and what hospitals build, the agency would be duplicating a process that already takes place on the statewide level. Currently, hospitals cannot build new facilities without obtaining a certificate of need from the state.
Bishop also said that health care issues should be dealt with on a statewide basis, since some local hospital systems such as Providence Health System maintain facilities and clinics outside the Portland metropolitan area.
'Regulating the facilities within the region doesn't necessarily get to the larger statewide issues,' Bishop said.
Karen Kane, Metro spokeswoman, cautioned that at this point Metro is merely studying the local health care landscape in advance of deciding whether to become involved. That decision should come in August, she said.