Small Thoughts on the Big Picture: Health Care Reform
Over the last couple of weeks I have been working more and more closely with the CIDP /Hospital to Home project. I am really enjoying this opportunity to work with such a new and exciting project that will hopefully lead the way in improving quality of care for patients with chronic illnesses or diseases.
So, instead of giving the daily/weekly summary of my work at Woodhull, I wanted to make this post, and others that I’m brainstorming as I type this entry, about how this experience is making me more concerned about the health care system as it currently stands but, also how impressed I am with the innovative ideas Woodhull Medical and Mental Health Center, under the omnipotent and omnipresent (love those words) support of the New York State Department of Health and New York City’s Health and Hospitals Corporation, is working to put into action to challenge the situation.
I think what I have witnessed this summer is what I hope to be an indication that the health care system is changing slowly but surely to better serve its patients and citizens and that hopefully the impending Health Care Reform from the White House and the Department of Health and Human Services will only expedite this major overhaul that is much needed.
After a large amount of observations day in and day out that often times that I think might bore some (except for my parents) if I were to take you minute by minute through my days here for the last 6 weeks, I feel all the more enlightened from them. I’ve begun to do some continuous research. I scan the front page of the NY Times in the mornings.as I sit and eat my breakfast with my eyes half open, for updates on Health Care Reform. I’ve also begun to click forward to Whitehouse.gov for any updates (staying away from Twitter these days because one line headlines don’t really cut it) and I have also begun to read the DHHS’s website, more specifically “Health Disparities: A Case for Closing the Gap.” You can visit it here: www.healthreform.gov/reports/healthdisparities/index.html
But, I wanted to highlight something really important from it:
Lack of a Primary Care Provider and Usual Source of Care
A primary care provider and a facility where a person receives regular care substantially improve health outcomes. However, Hispanics are only half as likely to have a usual source of care as Whites. What’s more, half of Hispanics and more than a quarter of African Americans do not have a regular doctor, compared with only one fifth of Whites.14Low-income Americans are three times less likely to have a usual source of care compared to those with higher incomes – and almost half of low-income Hispanics lack a usual source of care.15
Communication with a Health Care Provider
Poor communication with health care providers results in a host of problems including less access to preventative care and higher rates of re-hospitalization. Asian Americans, African Americans, and Hispanics all reported having poor communications with their doctor more often than Whites. For Asians Americans, the gap has increased over time.( Courtesy of the Department of the Health and Human Services Website: www.healthreform.gov/reports/healthdisparities/index.html)
This comes from the DHHS’s case for Health Care Reform. They are certainly strong points. Who could argue against them? Taxpayers who don’t want to fork over the money to change the situation and their faithfull law makers who represent them in Congress. It’s obviously far more complicated than that, and I acknowledge it, even based on my experiences at Woodhull. Health Care Reform will certainly be expensive as we try to cut the costs for patients while still improving their quality of care.
It’s too bad for them because Health Care Reform has already begun in small stages, especially here at Woodhull and most certainly within the city of New York. More to the point, I wanted to acknowledge how realistic these statistics are and why they make such a strong case for reform.
A large portion of patients lack a primary care physician and rely on Medicaid/Medicare/HHC Options for support.
I would argue a majority of patients don’t have a primary care physician. Sure, by coming to the clinics they see the necessary attending doctor but, that doesn’t mean those doctors are their primary care physician. Those are mostly specialty doctors besides of course the Internal Medicine doctors and the pediatricians. The statistics that I cited above certainly wave their flags at me every day as I walk the halls of Woodhull, “Hispanics are only half as likely to have a usual source of care as Whites. What’s more, half of Hispanics and more than a quarter of African Americans do not have a regular doctor, compared with only one fifth of Whites.”
Day in and day out, the language barrier is evident among patients and their providers. Woodhull hospital has a translation service with two way phones and works with interpreters constantly to help surmount this issue. However, it’s still difficult, no matter the effort, for patients to fully understand doctors if not for language barriers, for cultural ones.
Every day on my way into the hospital and up to the 6th floor where I work I pass HHC options, Medicaid/Medicare offices and the long row of health insurance providers’ booths beckoning interested patients with their wide variety of options. I pass hundreds of patients every day, probably most who rely on the former options for health insurance than the latter. For those who are not familiar with HHC options, it stands for Health and Hospitals Coorporation Options and it is a program designed for patients who do not meet the income requirements for Medicaid but, can not afford insurance based on their income. They must meet a specific income requirement to be a candidate client. The program is fee for service, meaning that the patient pays a certain amount for the medical services they receive based on their income.
So, when someone can not afford health insurance, does not have a primary care provider and/or can not take off work to make visits to the hospital they can easily wind up going to the emergency room for care or using the hospital care on almost an abusive basis. Don’t get me wrong, hospital care exists to help those who are sick but, having a primary care physician who can manage your care with you over the years and understands your medical history, can vastly improve your quality of life and of care. Statistics from the DHHS agree:
Routine Care
People who do not have access to a usual source of primary preventive health care are more likely to end up in the emergency department or in the hospital. Indeed, African Americans use the emergency department at twice the rate of Whites.16Low-income adults and children struggle to obtain routine but needed care that serves to prevent the occurrence of more serious health problems. Twenty percent of low-income Hispanic youth have gone a year without a health care visit – a rate three times higher than that for high-income Whites.17
( Courtesy of the Department of the Health and Human Services Website: www.healthreform.gov/reports/healthdisparities/index.html)
Routine care is incredibly important. Learning and understanding the appropriate way to take care of yourself and the illnesses you might have must come from a primary care physician who can closely monitor and continuously alter your care according to developments or changes in your health. Working in Woodhull, it’s very easy to understand how patients without a primary care physician, who have a low income, possibly work two jobs, have children and relatives to take care of, don’t have time to be concerned with regular appointments and instead rely on the ED when the going gets too tough.
But, I am witnessing improvements and changes to the care for patients who lack a primary care physician, especially those with chronic illnesses or conditions. Hospital to Home is a program that directly exemplifies the changes that are taking place for patients with these obstacles. As I have detailed before in an earlier post, each patient receives a care team that includes a primary care physician and this group works with the patient to improve all aspects of their life because in reality all aspects play into one another. Whether it’s getting a patient with Chronic Obstructive Pulmonary Disease to stop smoking, or a patient with liver disease to stop drinking, getting a homeless man with chronic cellulitis out of the bacterial cesspool that is life in the streets and into a home, it’s always the small things that end up fixing the big things. For example, Mr. T who could never make his appointments because he never could walk far enough and make it on time to the bus, reduced his dependence on the emergency room for leave-it-to-the-last-minute care because his team from Hospital to Home helped to get him ambulatory service to make his appointments.
We should sweat the small things.