SANDFORD, Idaho — Panhandle Health officials presented a four-month review of clinical services to Bonner County commissioners on Jan. 14, detailing patient volumes, program revenues and county contributions and prompting debate over the proper role of public-health clinical care.

Dr. Pinnock, who led the review, told the commissioners that district-wide support for Panhandle Health totals about $2.5 million and that clinical services receive roughly $661,000 of that support — about 26 percent. He said Bonner County’s total contribution to the district is approximately $514,000, with about $136,000 allocated specifically to clinical services, which Pinnock estimated amounts to roughly $2.50 per county resident for clinical programs.

“There's too much emphasis on infectious and communicable diseases, too much emphasis on vaccinations, too little emphasis on chronic diseases, noncommunicable diseases, and prevention,” Pinnock said, summarizing what he described as the presentation’s central finding and arguing for stronger chronic-disease focus and physician leadership at the operational level.

Pinnock presented utilization data showing roughly 4,200 unique patients district-wide and about 750 unique patients in Bonner County, with about 7,500 total encounters across the district and roughly 1,100 in Bonner. He said the top diagnostic groups seen in clinics were immunizations, family planning/gynecology and mental health, and that the clinic’s payer mix is broader than solely indigent care: only about 9.5 percent of patients use the sliding-scale discount program, he reported.

Commissioners pressed whether Panhandle Health’s clinical offerings duplicate services already available through federally qualified health centers (FQHCs) and private providers. One commissioner said the health district appears to serve a wide economic cross-section of patients — not only indigent residents — and questioned whether county tax dollars should underwrite services that some private providers could offer.

“If government has no role in the rendering of clinical services…then my question is, what is the appropriate scope of enterprise for the entity that we call public health?” said Dr. Fletcher, Panhandle Health’s board chair. He urged the board to consider both fiscal and legal constraints before changing clinical programs and said the board had formed a finance subcommittee to produce formal fiscal notes.

Other commissioners highlighted Bonner County’s mental-health needs and recent local suicide counts as a reason to prioritize services that are not readily available elsewhere. One commissioner urged Panhandle Health and county leaders to prepare competitive proposals for a state rural-transformation fund so the region can secure infrastructure and telehealth funding if the county wishes to expand mental-health services.

Speaker 6, representing district directors’ discussions with state officials, described the program as roughly $168 million spread over five years and said competitive grant guidance and legislative spending authority are still pending; district staff cautioned that the first rounds of funding are likely to be competitive and that applicants must match the program’s stated priorities.

Pinnock and commissioners agreed on several operational gaps that need better measurement: longitudinal health outcomes (ER visits, hospitalizations and disease-specific metrics), local access and timeliness, and county-by-county variance in service needs. Pinnock said clinic visits and vaccinations have declined from 2015 to 2025 (with an expected COVID spike), and that revenue and cost lines have diverged since about 2022, producing a steady district support requirement.

Commissioners asked for additional county-specific breakdowns and data comparing Panhandle Health’s services with FQHCs and other community providers. They also requested that Panhandle Health share presentation materials and grant criteria and scheduled a follow-up, pre-budget planning session to continue the conversation.

The meeting ended with no formal vote or policy change; commissioners directed staff to coordinate a follow-up meeting and to circulate the materials and grant requirements discussed during the presentation.