Care for the Uninsured:

Examining local options to meet the growing need

by Rodney Berry
with research assistance by Public Life Foundation staff Beverly Mills and Kathy Strobel

Local Options for Serving the Uninsured
Those who support might say...
Continue as we are Rely on the OMHS Emergency Department as the primary safety net for the uninsured. Invest in space, staff and equipment to meet the growing needs of the uninsured.	Increase the capacity of clinics Enable clinics (McAuley Clinic, Free Clinic, and REACH Clinic) to absorb more non-emergency care for the uninsured that the OMHS Emergency Department manages currently. Develop sustainable funding and expand staffing, hours, and marketing of the clinics. Explore the merits of merging one or more clinics.	Assign more uninsured patients to primary care physicians Using the DC-CAP mechanism, equitably distribute more uninsured patients among primary care physicians. Increase and sustain funding to increase the capacity of DC-CAP to recruit physicians, manage and promote the program.
The OMHS Emergency Department already serves nearly 14,000 uninsured patients per year and absorbs $5.5 million annually in uncompensated care. It is fully and professionally staffed and best equipped to meet this need. Most uninsured people will continue to turn to the hospital for care. They know they will not be turned away. Emergency physicians, specialists, ancillary services and equipment are readily available when needed. We do not have enough primary care physicians to meet the needs of the uninsured. Clinics are important to supplement the hospital using volunteers, retired physicians, and grants, but their capacity is limited.	The cost per patient at local clinics is substantially less than the OMHS Emergency Department. We should make investments to increase the capacity of clinics. If a significant number of non-emergency uninsured patients can be diverted from the OMHS Emergency Department, cost savings could be reflected in lower hospital charges and insurance premiums. Clinics are better positioned to provide primary care than the hospital emergency room. Without expanded clinic staff and hours, the uninsured will continue to use the Emergency Department as their primary source of care.	This is the best way to get uninsured patients into a medical home for health education, prevention, and early detection. The problem is manageable if all physicians and ancillary health care facilities and personnel participate in caring for the uninsured. We have an effective mechanism in place with the DC-CAP program. Ten primary care physicians and 54 specialists are enrolled already.
Those who oppose may say...
The OMHS Emergency Department is designed for emergencies, not primary care. The uninsured need and deserve a medical home, a relationship with a doctor who knows their history. Health education, prevention, and early detection are more likely to occur through primary care providers. Uninsured patients need assistance beyond emergency room treatment: prescription drug assistance, tests, referrals to specialists, and follow-up appointments to a primary care doctor. Emergency room care is the most expensive form of care. By relying on the Emergency Department for non-emergency care of the uninsured, the public pays for that care in higher hospital charges and insurance premiums.	There is no dependable source of funding for expanded clinic staff and hours. Grants that have been used to purchase medications are not dependable. Clinics are not operating at full capacity currently. There is no guarantee that the uninsured will use clinics over the OMHS Emergency Department even if they are expanded. If clinics absorb more charity care that otherwise would be directed to the OMHS Emergency Department, there is no guarantee that OMHS would pass along cost savings.	Most physicians already accept uninsured patients and reimbursements from Medicare and Medicaid are increasingly low. Physicians are also obligated to donate service while on staff call at OMHS. There is a limit to what they can do. We do not have enough primary care physicians to absorb the large number of uninsured patients. In May 2004, Daviess County’s 62 primary care physicians were eight fewer than McCracken County (Paducah), 31 fewer than Warren County (Bowling Green), and 12 fewer than Boyd County (Ashland). Some physicians will not accept uninsured patients. Consequently, those that do will have to accept an unfair financial burden of caring for non-paying patients. Despite a diligent effort, only10 primary care physicians have agreed to accept uninsured patients through the DC-CAP program. Unless many more physicians sign on, this option cannot come close to meeting the need.

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