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More
than one million Virginians have no health
insurance. That
fact, reported recently by the U.S. Census Bureau,
is itself alarming. But when you stop to consider what it means
in human terms, it is all the more disturbing.
One in every seven of our neighbors has no
family physician, no pediatrician for their kids, no
cardiologist or oncologist for specialty care.
X-rays, MRIs, blood work and other diagnostic
tests are prohibitively expensive.
Prescriptions for therapeutic medicines go
unfilled. That
the uninsured die younger and get sick more often is
a sad but predictable fact.
Perhaps
nowhere in the Commonwealth is the situation more
acute than in Southside.
Residents of Danville and Pittsylvania
County have endured trying economic times.
Textile mills, long a source for steady jobs,
have shuttered, and tobacco farming, once the
region’s stable cash crop, has proved less
profitable for small farmers in recent years.
As
a consequence, the rolls of the uninsured have grown
longer. More
than 21,000 area residents – every one in five –
are without health insurance. Thousands more are underinsured,
a condition that in practical terms means much the
same – no access to ongoing, affordable care.
The
impact on the region’s physical health is tragic.
Danville
has one of the highest infant mortality rates in the
nation. Incidence
of heart disease, stroke and kidney failure is twice
the state averages, as is the prevalence of obesity,
hypertension, elevated lipids, diabetes and tobacco
use.
The
result is a one-two punch that strains the
infrastructure of emergency care.
The uninsured not only suffer from chronic
ill health – due to their reluctance to seek care
they cannot afford – but once they do finally
reach out, they do not have access to the long-term
comprehensive treatment they need.
When treating the uninsured, emergency room
doctors are not so much finding broken bones or
bleeding gashes as they are facing patients with
arterial sclerosis, prostate cancer or hypertension.
Suddenly, these patients are confronted with
a stark reality: there are few options available to
help them get better.
James’
case is typical. Married,
in his mid-50s, and without health insurance, he had
been complaining for weeks of chest pains, until
finally, his family convinced him to go to the ER.
After an examination and tests, doctors
determined that James had significant heart
blockage. When
he was told that he would need bypass surgery right
away, James dressed and went home.
He knew he could not afford expensive
surgery. Two
weeks later, he suffered a heart attack.
Danville
Regional
Medical
Center
serves patients under a physician’s care as well
as those requiring emergency treatment. The hospital, however, has neither the
resources nor the structure to provide the kind of
long-term care that many chronically ill patients
need. The
center cannot, for example, ensure that patients are
filling prescriptions or taking their medications.
It does not have the capacity to coordinate
follow-up care or manage integrated treatment among
specialists. It
cannot compel James or others like him to submit to
treatment, no matter how urgent or vital.
Traditionally, these integral roles are
played by primary care physicians.
They are the foundation upon which our
healthcare system is built.
The
cost of a primary care doctor, however, is often
beyond the means of a family without health
insurance. As
in Danville, many uninsured residents turn to a free clinic,
staffed by volunteers and usually funded through a
combination of government and private monies.
But the Danville Free Clinic is open one
night a week. It
can care for just 30 patients weekly.
Attending physicians, while dedicated and
able, can provide only limited help with specialty
care. Still,
the Danville Free Clinic cannot meet demand.
If you think your doctor’s office waiting
time is long, consider the two months that Danville
residents must wait for an appointment at the free
clinic.
If
local initiatives have their limitations, so do
their federal counterparts, which are available to a
narrow slice of those in need.
Medicare coordinates healthcare only for
qualified seniors. Medicaid
provides coverage for only the poorest of the poor,
those with no real assets.
Many uninsured patients face an unthinkable
choice – forfeit their homes or forego potentially
life-saving care.
Within
this climate, an informal group of doctors and staff
from the Danville
Regional
Medical
Center
and the Danville/Pittsylvania Academy of Medicine
set out three years ago to find a solution, to
determine how to give the uninsured members of the
community access to quality, integrated care.
After a year of exploration and research, the
Danville group founded Project Access of Danville (PAD).
While
some public policy experts believe the remedy to
caring for the uninsured lies in increasing support
to free clinics, Project Access represents a
different approach. It
is not itself a clinic, nor does it provide care in
any way. PAD
is more of a facilitator, coordinating an
interconnected force of physicians, labs and
pharmaceutical companies, all of which have
volunteered to provide free
services and medications to Project Access clients.
There
are 17 Project Access programs around the country,
but in Danville, we have implemented a range of innovations that
distinguish us. In
addition to putting a comprehensive data tracking
system in place (which tracks patients and their
outcomes), we have instituted a case management
system and disease management program.
Since
the program opened its doors a year and a half ago,
more than 100 doctors have agreed to participate.
Primary and specialty care physicians see
between six and 10 clients regularly, giving them
the continuity of care that they otherwise would not
receive. The Danville
Regional
Medical
Center
is covering diagnostic tests, including X-rays,
blood work and in-patient admissions, and Central
Piedmont Health Services is providing primary care
services. As
for prescription drugs, a topic of debate on the
national stage, pharmaceutical companies have agreed
to provide free medications.
This
network of physician volunteers is fundamental to
the program’s success, as is the support from
throughout the area’s healthcare community. In addition to the local hospital, PAD is
working closely with clinics, social and health
services agencies, the mental health association and
other partners –- all dedicated to helping provide
access to care. Last
year, the federal government added its support.
PAD received a Community Access Program grant
from the Department of Health & Human Services.
The $865,000 award has enabled the program to
expand services and hire a full-time administrative
staff. This
fall, PAD was awarded year-two funding.
Despite recent beginnings, Project Access of
Danville is already making a life-and-death
difference, having screened 1,000 local residents to
date. The
program has set out to help empower the working
poor, to impart a sense of responsibility about
their own health. Providing
access to care is but the first step.
The uninsured need to recognize that with
such access comes an obligation to themselves and
their families to seek out regular medical
attention, long before they need it.
By
affecting this change in attitude, programs like PAD
should improve the overall wellness of the community
and lead
to a significant reduction in non-emergency visits
to hospital ERs. That
is good news for the one million Virginians without
health insurance, but it is also good news for the
rest of us. Improving
our collective health and minimizing trips to
emergency rooms will lead to reduced healthcare
costs across the board and lower premiums for those with health insurance.
--
March 10, 2002
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