Antonia Coello Novello got off a train in New York City two minutes after the first plane hit the World Trade Center on September 11, 2001.
The next several weeks were a scramble as the New York State Commissioner of Health coordinated the response of emergency medical teams, hospitals, clinics, and morgues.
"September 11 and the response to it was never taught in medical school," says Dr. Novello, one of the finalists for the 2006 Hispanic Business Woman of the Year award. "It tested your immediate response to the unknown."
$49.4 Billion Budget
These days, her job involves less crisis management, but even larger responsibilities. The New York State Department of Health has a 2005-06 budget of $49.4 billion, up from $26.9 billion in 1999, the year Dr. Novello was appointed commissioner by Governor George Pataki.
Dr. Novello manages an agency with 6,500 employees who supervise and regulate 239 hospitals, 667 nursing homes, 73,000 doctors, 241,000 registered nurses, and 60,000 emergency medical technicians. Despite these heavy responsibilities, she spends her time on the big questions of health, such as access to care and economics. "When I took this job in 1999, I thought being health commissioner would be like medicine, but this is more like public policy," she says.
"One thing about Tony – she's not a bureaucrat, she's very much an individual," says physician-executive Herb Pardes, CEO of New York Presbyterian Hospital, who has known Dr. Novello for 10 years. "She brings life and vigor to her program, whereas others might carry it out in a less imaginative way."
Care Financing Strategy A National Example
Her influence extends beyond New York because the state offers a demographic exper-iment for national healthcare programs. The state has a population of more than 19 million, of which 16.3 percent is Hispanic and 15.8 percent is African American. Patients speak 169 languages. New York also has about 3 million people in the 65-plus age category.
The Department of Health runs 10 programs for the uninsured. Several follow familiar templates, such as Medicaid and the Child Health Plus program, but others show Dr. Novello's imaginative approach.
For example, New York's school-based health centers allow school nurse offices to provide care for asthma, infections, and other conditions. Dr. Novello points to this program as an example of greater efficiencies in care because parents don't have to get out of work to take their children to a doctor. "There was a cycle that had to be broken, so why don't we take care of children in schools?" she asks. The program currently serves 200,000 children at 187 schools.
A larger program covers what Dr. Novello calls the working poor. "They're poor enough that they don't have insurance, but rich enough that they don't qualify for Medicaid," she says. The Family Health Plus program has nearly 500,000 adults enrolled.
The crucial trick in Dr. Novello's agenda focuses not on accessing care, but on paying for it. "Everywhere I go, I tell [people] that New York has found ways to take care of the poor," she recounts. The state's solution comes from an 8.9 percent surcharge on outpatient clinics and medical offices, plus a 1 percent charge on hospital billings. "That accumulates to $4 billion per year. With that, we pay for all those programs I described," Dr. Novello explains.
Balancing Provider & Patient Realities
"The finances of healthcare institutions are challenging – a lot of hospitals are in deficit, and quite a few have gone bankrupt," says Dr. Pardes. "[Dr. Novello] is good at balancing the need for care with the needs of the care providers for financial solvency."
In gathering support for her programs, Dr. Novello's assertive personality has proven a real asset. "She's well respected throughout the state, not only for addressing health issues, but also as a person," says Republican Senator Joseph Bruno, majority leader in the New York State Senate. Dr. Pardes describes her as "very personal, warm, engaging, with a good sense of humor, savvy regarding the politics of healthcare, and committed to quality care."
When talking about her Hispanic heritage, she shows her characteristic frankness. "We don't have to feel we are the minority – we are the emerging majority," she says. "I feel the best revenge is success. I always try to do the best I can, because I feel I represent those who have no one else to represent them."
Dr. Novello made history in 1990, when President George H. Bush appointed her to the position of U.S. surgeon general, the highest health officer in the federal government. She was the first Hispanic and the first woman to hold the job. "As surgeon general, I became a role model – one of the most frightening things that can ever happen to anybody," she recalls.
Previously, she worked for 11 years at the National Institutes of Health. Her medical career began when she earned her medical degree at the University of Puerto Rico. She later completed training at the University of Michigan, Georgetown, and Johns Hopkins, where she earned two advanced degrees.
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