Clear standards will help administrators enforce the contract's provisions. Tracking performance and sharing data with the public also will give voice to the many patients who lack the means to take their business elsewhere. Good monitoring is rare in health care, especially for services to low-income public clients. But it can be done if the District consistently applies pressure to measure up. Second, the council should do what it can to lock in future funding.
Experience shows that safety net support can wane after privatization.
A private contractor may not fight for enough funding to cover the needs of indigent patients, so the council must extract concrete promises from the mayor to continue funding. Of course, political promises aren't binding, but they do resurface during hearings and elections. The District also should follow the lead of other communities by seeking federal funds to support its health care safety net. Medicaid research and demonstration projects have provided support in Los Angeles and New York. Even Boston's system, which is partly privatized, as the District's will be, has received help.