There's a breath of life yet in the state's struggling network of public hospitals.

The Hawaii Health Systems Corp., which manages the network of 13 hospitals, is in line to get an additional $69.6 million in state and federal funds.

It would be enough to keep the hospitals open for now. But making them healthy, and a dependable contributor to the communities they serve, will be a harder nut to crack. The hospitals must find ways to manage costs without eliminating essential services. Those who depend on them — 60 percent are on government programs and many are uninsured — often have nowhere else to go.

To accomplish this, they have to be efficient, flexible to changing economic conditions and more responsive to the communities they serve.

This kind of reform is the goal of Senate Bill 1673, passed by the Legislature and under consideration by Gov. Lingle. It gives local administrators on each island greater control of their hospitals.

Regional boards and the hospitals they administer could partner with private entities — or go private themselves — to be more competitive. They could reduce or eliminate costly or unneeded services after consultation with the community, without going through the Legislature. And corporation or regional boards could negotiate directly with public unions.

It's possible that as the regional boards flex their new muscles, they could dramatically change the face of the public hospital system. But with greater local control comes greater local responsibility. The regional boards must ensure their decisions are made with the full transparency and community involvement demanded of public agencies.

They must weigh the benefits of belonging to a large public network — with its economies of scale and buying power — with the nimbleness of private enterprises.

Most of all, they must protect not only the bottom line, but the lives and health of those they serve.