The Private Sector Pitches In for the Uninsured: Part 3 of a series

Physicians are sensitive to their patients’ out-of-pocket costs. A recent study by H.H. Pham (Arch Int Med 2007;167(7):663-8) reported that 78% of physicians considered cost when prescribing medications, whereas 51.2% reported doing so when selecting care settings, and 50.2% did so when choosing diagnostic tests. Primary care physicians were more likely than specialists to consider patients’ out-of-pocket costs in choosing prescription drugs (85.3% vs 74.5%), care settings (53.9% vs 43.1%) and diagnostic tests (46.3% vs 29.9%).

While few would argue that being uninsured beats having coverage, private sources provide a significant amount of charity care. Such care strips the patient-physician bond to its essence-providing care the patient absolutely needs rather than what insurance will pay for. Senator Tom Coburn, MD (R-OK), estimates that one-third of medical care is wasted because people don’t have incentives to use it wisely and that insured persons use twice as much medical care as the uninsured. These are important statistics in the debate for expanding insurance coverage.

Web Sites of Interest

• American Projects Access Network: www.apanonline.org
• Center for Studying Health System Change: www.hschange.com
• Commonwealth Fund: www.cmwf.org
• Covert the Uninsured Week: www.covertheuninsured.org
• The Foundation Center: www.foundationcenter.org
• Kaiser Family Foundation: www.kff.org
• MetLife Foundation: www.metlife.org
• National Association of Free Clinics: www.freeclinics.us
• Robert Wood Johnson Foundation: www.rwjf.org
• W.K. Kellogg Foundation: www.wkkf.org

A 2007 Template for Charity Care

The Coastal Medical Access Project (CMAP) is one of 21 programs assisted by the American Project Access Network and studied by the W.K. Kellogg Foundation as a template for charity care. CMAP covers three counties in southeast Georgia, a fast-growing area with 22,000 uninsured from business downsizing, an immigrant influx, and working uninsured.

Following APAN’s blueprint for indigent care, CMAP offers volunteer free care clinics, pharmaceutical assistance, and intense case management. Two physicians, two nurses, a social worker, and four lay volunteers staff each clinic session, from a pool of 29 primary care physicians, 40 specialists, 35 nurses, and 100 volunteers. Through electronic medical records, they transmit clinical data, do case management, and coordinate referrals and scheduling. CMAP has arranged more than 200 specialist visits and 25 surgeries and provided $5.7 million in free pharmaceuticals.

CMAP’s model has been adopted in other parts of Georgia and a new initiative for Troup County is now forming.

©2007 The Triological Society