EDITORIAL : SUPERVISORS' PRESCRIPTION; L.A. COUNTY-USC DECISION IS ONE PART OF LENGTHY PROCESS.

THE Los Angeles County Board of Supervisors acted responsibly when it voted last week to build a smaller replacement hospital for the aging, quake-damaged County-USC Medical Center.

But the supervisors' decision is just one step in a long journey.

There will be much planning and coordination and more difficult decisions to deal with in the coming years if the county is going to have a working system of public health care for millions of uninsured residents.

The supervisors voted for a 600-bed replacement, instead of 750 or more as some had urged. The current facility in Boyle Heights is licensed for 1,700 beds, although it's filling about 860 beds a day. It's the largest of the county-owned hospitals in the health care system operated by the county Department of Health Services. County-USC was damaged in the 1994 Northridge Earthquake, and much of it is showing signs of age and inefficiency.

There is a federal policy emphasis - as well as a general health care trend - away from in-hospital treatment and increasingly toward outpatient services.

The federal government gave the county a waiver - in conjunction with emergency funds when the county faced a 1995 budget crisis - requiring the county, by the year 2000, to reduce by one-third the average number of admitted patients and to show a 50 percent increase in the department's ambulatory care capacity.

In short, the county needs a well-managed effort to increase the use of ambulatory care as an alternative to inpatient care and to reduce the average length of a patient's stay in county hospitals.

A majority of County-USC's uninsured patients are full-time workers or their dependents. They include many self-employed persons and employees of small businesses.

From a financial standpoint, the supervisors' decision was the right one - trying to stretch available dollars but not overspending, which would create a new financial crisis. Now the county needs to continue working to build a health system that maximizes dollars and provides care to the uninsured, working poor.

It's also clear that the county needs to develop new sources of revenue for health care, especially if it will increase its reliance on contracts with private hospitals to provide indigent care. Medi-Cal rules would have to change.

The public needs realistic, practical answers. There's no simple solution, but vast numbers of people in the San Fernando Valley, Los Angeles and across the county care deeply and are directly affected.

It is important for public officials to work collaboratively for sensible programs that will improve the community's health at a price it can afford.