Friday, September 17, 2010

The Access Mess – What Doctors Can Do

America is in the midst of an economic and health access mess.

Look at the numbers – 15 million unemployed, 1 of 7 mired in poverty, 51 million uninsured, and a 50,000 shortage of primary care doctors.

Lack of access comes in many forms - access to jobs; access to food, housing, social services, transportation; and access to medical care.

Where do Americans go to get acute medical care? According to a recent Health Affairs article,

• 42% go to a primary care physician

• 28% go to the emergency room

• 20% go to a specialist

• 7% go to an outpatient department

• 50% of the uninsured go to an emergency room, where ER doctors, 5% of all doctors, care for them.

Access problems contribute to rising medical costs.

• Dr. Richard Cooper, professor of medicine at the University of Pennsylvania, has shown the level of poverty directly correlates to soaring health costs. Medicare costs are higher in Mississippi, the poorest state, and in poverty-stricken inner cities.

• If you are unemployed and a family member becomes ill, you may not be able to afford a visit to the doctor, prescribed medications, or preventive services, thus delaying treatment, intensifying the illness, and raising costs when intervention becomes necessary.

• When you do receive care, you may have to return to a setting or a family where money is scarce, housing inadequate, conditions are unsanitary, transportation to medical facilities is unavailable, drug use is rampant, and help and advice to assure medical compliance is absent.

Most of these socioeconomic conditions are beyond the scope of medical practice. Doctors cannot control poverty, unemployment, health insurance, or the education of more doctors.

So what can doctors do? They have bills to pay, practices to maintain, creditors to satisfy. They can do more charitable work, they can offer discounts, they can spread out payments for medical bills, they can work more closely with social services.

They can volunteer for free clinics, such as those in North Carolina. North Carolina has 79 of these clinics, the most of any state, and there are 1200 across the United States. They can refer patients to any of 3000 community clinics, supported by the federal government and started by President Bush and supported by President Obama.

They can become aware of and financially support innovative organizations like Project Health, which has a new vision for American health care. Here is their vision.

“For low-income youth and families, traditional medical care is not sufficient to improve health outcomes. A prescription for antibiotics is not enough when there is no food at home. Poor health further entrenches families in poverty by jeopardizing educational attainment, economic stability, and life opportunities.”

“Founded in the Boston Medical Center Pediatrics Department in 1996, Project HEALTH's approach is simple but effective: We enable doctors to "prescribe" food, fuel assistance, housing, or other resources for their patients, just as they do medication. Patients take these prescriptions to our Family Help Desks in clinic waiting rooms, where our college volunteers "fill" them by connecting patients with these critical resources. Last year, Project HEALTH trained and mobilized nearly 600 college volunteers serving over 4,000 low-income patients and their families in Baltimore, Boston, Chicago, New York, Providence, and Washington, D.C.”

“Our impact is two-fold: Our Family Help Desks expand the capacity of clinics to connect their patients with the resources they need to be healthy. At the same time, by providing a transformative experience for our volunteer corps, we are producing a pipeline of new leaders with the skills, knowledge, and experience to bring about change in the health care system.”

Doctors can make a difference.


1.Stephen Pitts, et al, “Where Americans Get Acute Care,” Health Affairs, 29, No.9, 1620-1629, 2010.


3. Medinnovation blog, April 9, 2010, “Closing the Gap Between Poverty and Poor Health, An Interview with Rebecca Onie, Founder and CEO, Project Health

No comments: