The S.C. Legislative Audit Council recommended Tuesday that the state consider one "mega" agency to oversee all health services, rather than eight agencies with splintered functions.

The council says the move would save money and eliminate duplication in health services, a third of the overall state budget.

But health-care providers worry that consolidation might endanger some of the state's vulnerable people, whose needs could get lost in a large bureaucracy.

Now health services are provided by eight different agencies, from large ones with sweeping regulatory functions such as the Department of Health and Environmental Control to smaller ones with focused missions such as the Commission on the Blind.

The council says that the Department of Health and Human Services should be the umbrella agency. Its director would be part of the governor's Cabinet and he would oversee the directors of all the other agencies.

This would be a drastic change, as five of the eight agencies in question are run by autonomous boards. For the most part, they act independently of one another.

The proposal is sweeping and would have a tough time becoming reality, given the political heft of some of these boards and the desire of clients to keep their key contacts in one place.

But the recommendations jibe with Gov. Mark Sanford's desire to reorganize state government, giving more power to the executive branch rather than appointed boards.

A Sanford task force recommended last week that some of the same agencies in the council's report become part of his Cabinet.

Sanford said Tuesday that the report highlights two of his priorities: fiscal responsibility and government accountability.

"We don't accept waste and duplication in the business world and we shouldn't accept it from state government either," said Sanford, in a prepared statement.

In response to the audit, most agencies said their chief concern was whether their clients would receive the same quality of services. Also, they said they hoped the state would give a great deal of consideration before merging services.

Some agencies, such as the Department of Disabilities and Special Needs, were split off from umbrella organizations in the past because they serve unique needs.

"Families and policy makers made the case that persons with severe lifelong disabilities who cannot take care of themselves need a significant voice speaking for them," said DDSN director Stan Butkus.

"Experience here ‘.‘.‘. shows that the special population whose severe disabilities are from birth to death get lost in the mix of an agency with wide generic responsibilities."

But a Health and Human Services spokesman said it would do what it has always done -- follow the law.

"Whether we'd rather be a super agency or not is immaterial," spokesman Frank Adams said. "We do what they tell us to do."

The audit was created at the request of the General Assembly, who asked last summer that the council review health spending. Changing agency structure would require legislative action in most cases.

Rep. Rick Quinn, R-Richland, oversees the subcommittee that writes the budget for health agencies. "I felt like it was a vindication of the work we've been trying to do," he said.

Quinn supports consolidating health functions, especially programs that are dependent on Medicaid -- the state and federal health program for the poor, disabled and elderly. The Medicaid budget has grown 25 percent in the last two years and is a major contributor to the state's budget crunch.

"When you get right down to it, the organization is part of the problem why Medicaid is growing so fast," Quinn said.

Quinn said he agreed with three-quarters of the report and would submit a bill this spring recommending some of the changes and others his committee has been working on.

"We've hit the wall budgetwise. We have to think outside the box and look at reforms."