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Published on May 29, 2020

What is a Public Hospital District


Laurene Burton discusses what a public hospital district is, how EvergreenHealth is governed and how the board of commissioners is different from private hospitals, as well as how public hospital districts are funded.


Melanie Cole (Host): Welcome to Check-up Chat with Evergreen Health. I’m Melanie Cole. And today, we’re talking about public hospital districts. My guest is Laurene Burton. Laurene has served as an Evergreen Health community advocate for over 25 years, working in community health education and most recently serving as Executive Director of Governance & Community Affairs. She has dedicated her career to furthering the health and well-being of Eastside families. Laurene, I’m so glad to have you with us today to discuss this. what an interesting topic. Tell us what is a public hospital district.

Laurene Burton, Executive Director of Governance and Community Affairs (Guest): A public hospital district is a governmental entity. It is municipal corporation also known as a junior taxing district. This is a special purpose district and for public hospitals, our charge is to deliver healthcare to our community.

Host: Wow. So, what is the difference between say a county healthcare system or a public hospital or a paying private hospital?

Laurene: Thank you for asking. One of the main differences is we are governed by seven publicly elected commissioners as opposed to a private hospital that may appoint their board of directors. Each of our publicly elected commissioners serve a six-year term and these are staggered. They also have sub-districts that three of them represent so that we make sure that we get a cross representation from our entire hospital district.

Another difference is that we are required to subscribe to the open public meeting act which means that all proceedings or meetings that we may have are open to the public. We are also open to the public records laws which means that the majority of our documents are available to the public and are very transparent and open.

We also have a gift of public funds clause which means that our public funds are restricted from being used for certain purposes.

Host: So, then how does the community benefit from a public district hospital model rather than the for profit? You explained the difference so well to us, what is the benefit to the community in that respect?

Laurene: Well one thing that I also neglected to mention is that all of our community members are investors. We do receive a levy from the community and those levy dollars are applied towards specific programs. They also are used to retire debt. One thing that our board does is that they set aside a certain amount every year to be applied towards specific programs that do benefit the public. We keep an eye on what the public needs through community health needs assessments, through feedback from the public and through feedback to our board of commissioners.

Host: Why then Laurene, do some counties have hospital districts while others don’t?

Laurene: They are publicly mandated. So, for example, when Evergreen was formed, there was a need within the community and a grass roots effort ensued and it went to the ballot. So, these are things that are really delivered to the public and the public votes to form a hospital district. Our hospital district was voted on in 1967 and began in 1968 with our doors opening in 1972.

Host: Is there any difference in the quality of physicians and staff at a public district hospital? Do people have concerns about that?

Laurene: We have a very high quality standard. In fact, we are in the top 2% of hospitals in the country. So, I would say there is absolutely no difference. Quality depends on your level of care, your level of physicians, your level of staff and there are a multitude of things that influence quality but being a private or a public hospital should not be one of them.

Host: Then let’s talk about how Evergreen Health is governed. How is the board of commissioners different from private hospitals? Now you mentioned that they are elected. How are they selected to serve? What goes on in the community?

Laurene: Well they are an elected official just like a school board member or a city council person. So, they actually have to go out into the community and sell themselves so to speak. Our board of commissioners have a term that last for six years. So, every six years, they are required to first of all sign up for an election and secondly, serve in that election which means campaigning just like any other elected official. So, those terms, those six year terms, once they expire; the commissioners do have to run again, they are not automatically appointed.

Host: Thank you so much for that description. So, how does a public hospital district fulfill that vital role in the state’s healthcare? How does it compare itself, does it, to the state hospitals or the private hospitals just generally in the state?

Laurene: We just like any other hospital, are required to submit data for our quality. So, all of that information goes to different quality accreditation committees, regulatory agencies. The information also goes to the Department of Health. So, we are on par with all other types of hospitals in terms of providing data that supports the kind of care that we deliver.

Host: Such an important point Laurene and how are they funded? You mentioned a little bit about it before. But get into a little bit more detail for us.

Laurene: In terms of the money that the hospital receives?

Host: Yes.

Laurene: So, we have a levy as I mentioned earlier which accounts for under 3% of our total income. We receive money just like other hospitals through Medicare, Medicaid, and through private pay insurance.

Host: Well and along those lines then, does a public hospital district have legal obligations to it’s community and other legal parameters like a nonprofit?

Laurene: We certainly do have those kinds of parameters. One thing that we feel as a public hospital district is that we are responsible for the health of our community. Which means we want to set aside funds that will serve our community on an individual basis so to speak. So, we have a program called Our Community Healthcare Access Team that is funded through our levy dollars. This is a very unique and important program. The program makes sure that every person that needs help getting access to care, receives that kind of access.

They also help navigate them through the system if they need insurance. That is a very unique program. We also have other programs that we have developed in response to the community needs assessment. And those kinds of programs again, specifically relate to those members in our community that need those services.

Host: How interesting. Many people don’t know about public hospital districts and you’ve explained it so well Laurene. Wrap it up for us, what else would you like the listeners to know about a public hospital district and specifically Evergreen Health?

Laurene: Well what I believe is so extremely important about Evergreen Health is that we do listen to our community. Our board of commissioners listens to our community. We were founded by the community for the residents here and to top it all off; our quality is amazing. We are in the top 100 in the country. Where else do you find your neighborhood hospital in the top 100, but here in Kirkland?

Host: Wow. That really is amazing. And what a great segment and thank you so much for coming on and sharing your expertise and explaining your amazing system to everybody. Thank you again. That wraps up this episode of Check-up Chat with Evergreen Health. Head on over to our website at for more information and to get connected with one of our providers. If you found this podcast so informative as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.

Laurene BurtonMeet the Expert

Laurene Burton, Executive Director, Governance & Community Affairs

Laurene was the Executive Director, Governance & Community Affairs at EvergreenHealth. She has worked at our organization for over 25 years and is a resident in our public hospital district.

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