In its discussion of ways in which the delivery of health care on the Kenai Peninsula could be improved, the borough’s Healthcare Task Force has encountered an obstacle that has, for better or for worse, halted attempts to change borough hospital governance structure on numerous occasions over the past several years.

The Kenai Peninsula Borough owns two hospitals — Central Peninsula Hospital in Soldotna, and South Peninsula Hospital in Homer. The hospitals are run by nonprofit boards of directors, but the borough government retains oversight of hospital operations. It’s an arrangement that poses both benefits and challenges. As business ventures — and let’s not forget, despite being publicly owned, hospitals certainly qualify as that — we want those organizations to be agile and able to respond quickly to changes in the marketplace. We want them to run efficiently, and to at least generate enough revenue to cover expenses, if not turn a profit.

But as a borough asset, we want decisions to be well vetted. We want governance decisions made via the sometimes drawn-out and clunky public process, which means review by governing bodies, opportunity for public input, and in some cases, send a decision to voters before any action is taken.

Over the years, there have been efforts to change hospital governance, either by selling the hospital outright, or entering into a partnership with a private company. However, borough residents have always been emphatic about maintaining borough ownership of the facilities, as well as public oversight, and proposals to change have generally been shut down before they’ve even been debated.

The health care industry continues to evolve, and management of the borough’s hospitals will need to evolve with it. Indeed, changes in the way the hospital does business already are under way. But — as the Healthcare Task Force has discovered — bigger changes to the way the hospitals operate will required changes to the way in which they’re governed. Ideas discussed by the task force have had a limiting factor of whether the suggested action is allowed under current regulations.

During a recent task force meeting, Borough Mayor Mike Navarre posed the question: “How do you allow that flexibility and at the same time maintain some level of responsible oversight?”

That’s a tough question, but one we hope borough residents and borough government continues to ask as the task force moves forward. For individuals, businesses, local and state governments, health care costs are one of the biggest budget items, and one that continues to grow. Because it owns the hospitals, the borough is in a unique position to do something about it, but to make that happen, borough residents may need to rethink how hospital ownership and management should look.