Some of the problem is due to the poor economy. As people lose their jobs and no longer have health insurance, more of them come to us for care. Our challenge is to treat them without swamping our own boat.

It's imperative that all members of the health care community figure out what they do best - then do it and leave the rest to others. For example, community health centers excel at providing culturally appropriate, team-based care for the most vulnerable of our residents.

We all face a growing struggle to find more budget dollars while operating more efficiently. What we must remember is that the answer doesn't lie only in cutting costs. We have to strike a balance around the "Triple Aim" of health care - cost, quality of service, and population health.

--Vanetta Abdellatif, Director of Clinical Integrated Services
Multnomah County Health Department