COMMENTARY
Community health centers a smart choice
By Beth Giesting
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In Hawai'i, as well as in the rest of the United States, an unacceptable number of people have no health insurance whatsoever. Since most health insurance is made available through the workplace, the current economic downturn is certain to result in a significant jump in the uninsured rate. The reason this must matter to all of us is that people who are uninsured often put off getting healthcare, quite understandably, which can be tragic when curable conditions that are neglected result in permanent disability or death. On the economic side of things, unaddressed health problems often end up requiring hospitalization, which can bankrupt the patient. If a critical mass of people is forced to use this approach to healthcare, it can also bankrupt a hospital.
The choices for uninsured people who do seek healthcare are vastly different. One path leads to the hospital emergency department. People who take this route for nonemergency care will likely wait many hours to be seen. The emergency room provider will fix the immediate problem and probably recommend that the patient get follow-up care. This visit will cost the patient at least a couple of hundred dollars. It will provide little or no help with what to do next, which may mean another acute episode that leads to another expensive visit to the emergency department.
The other path is to a community health center. The health center's primary care clinician will address the patient's immediate complaint, but equally importantly, CHC staff will also:
If ineligible for public insurance, the patient pays for the community health center visit on a sliding fee scale, discounted to what he or she can afford.
Which is most affordable for society? It may be surprising, but the better care option is also far less expensive. Community health centers, with their emphasis on primary care, prevention, and continuity, avoid the expense and waste of our fragmented healthcare "system."
What we term the "private healthcare system" is, for many, no system at all; patients often visit a series of specialists who order duplicative diagnostic tests and prescriptions, and there is no one keeping track of the long-range health of the patient. It's expensive, too. According to a study prepared by the Robert Graham Center using Medical Expenditure Panel Survey data for 2004, the overall annual cost to care for an uninsured person at a community health center is $922 less than in the private practice system.
In Hawai'i, the savings for uninsured care by community health centers amounted to $29 million in 2007. The community health center model is so effective that it saves even more money for people who have private insurance because its integrated approach prevents duplication and waste. The annual savings is $1,914 per privately insured person cared for by a community health center. In Hawai'i, that's $47 million per year.
Hawai'i has 14 community health centers on six islands. These private nonprofit institutions care for 110,000 children and adults of all ages with medical, behavioral health and dental needs; help patients and their families navigate the complex health and social service system; and provide caring assistance with respect and aloha.
Community health centers are good for our health and for our pocketbooks. With so much change and uncertainty in both our healthcare system and our economy, now is the time to embrace and support the efficiency and effectiveness offered by Hawai'i's network of community health centers.
Beth Giesting is chief executive officer of the Hawai'i Primary Care Association. She wrote this commentary for The Advertiser.
