Health Care District: Big Picture, Local History

Health Care District: Big Picture, Local History

What is happening with Alameda’s ongoing efforts to support our community’s local hospital and health care services with our funds and our participation in planning for the future? How did we arrive at our current situation? This is the first of several articles that will look at the larger forces affecting us, then share specific information and questions for us all to consider. 

Health system pressures and responses
A few decades ago, California was, for better or worse, at the forefront of major changes in hospital financing and patient care. These new pressures pushed some local health care districts to close their hospitals, while others sold or leased their facilities to larger hospitals or hospital chains. Meanwhile, our community was determined to continue our tradition of local emergency care and related health services. 

But outside pressures continued, and by 2002 our community faced a difficult choice: either close our local hospital or create a new health care district with authority to levy a parcel tax of up to $298 “so that the Alameda Hospital may remain open and continue to provide emergency and other healthcare services.” Slightly more than two-thirds of Alameda’s voters chose the second option, and Alameda Hospital was able to continue. 

Alameda Health System affiliation
Even after the 2002 vote of community support, outside forces continued to press our local hospital. Health insurance companies were consolidating and becoming more powerful, federal and state-level funding and coverage changes were squeezing hospitals and business groups pushed harder to cut costs and improve quality of care. 

We saw some local examples of the larger dynamics. These included Washington Township Health Care District’s hospital (in Fremont) affiliating in 2013 with University of California San Francisco. And that same year, San Leandro Hospital (in the Eden Health District) was transferred from Sutter Health to Alameda Health System. 

Meanwhile, our district’s Alameda Hospital continued to serve our community, while experiencing multimillion dollar annual operating shortfalls. The parcel tax dollars were helpful, but could not completely insulate us from larger forces of change.

Our situation now. When our health care district affiliated with Alameda Health System in May 2014, we looked forward to offering our community continuing emergency services plus access to specialty care (psychiatric, hospice, obstetrics, trauma). We also looked to accomplishing state-mandated seismic upgrades, and strengthening our Electronic Medical Record and other information systems. 

Big changes take time, but there have already been signs of progress. Our hospital’s financial situation has improved, and there are continuing efforts to strengthen our financial bottom line. Outdated patient care equipment is being replaced and upgraded, and many other facility improvements are happening. However, we may need at least five years of working together to effectively integrate our local culture and hospital into a system that is ten times our size and is itself looking ahead to plan for change. 

Ongoing Conversation. This is the first of several articles to inform you and to continue a conversation about our health care district’s role in offering future emergency and health-related services in our island community. Later articles will give more details on recent accomplishments, and on upcoming challenges and opportunities for the city’s Health Care District and the local community it serves. As always, we encourage each of you to bring your questions and comments to us board members at one of our public meetings, or by emailing us.


Kathryn Sáenz Duke is President of the city of Alameda Health Care District board of directors.  Reach her at