Job Losses Impact Clinics That Serve Those In Need

January 12, 2009
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Health care centers and clinics that serve the low-income, disadvantaged and uninsured are feeling the pressures of an ailing economy and rising job losses.  

The number of people seeking care from Cherry Street Health Services has expanded greatly, said Executive Director Chris Shea. He said it’s difficult to estimate how much demand has increased because the center has never really been able to care for all of the people who want to access its health services.

Cherry Street Health Services is a not-for-profit organization with 13 centers in the Grand Rapids area that provide comprehensive health services for low-income children and families. Cherry Street is not a free clinic, but 96 percent of its medical services are to low-income county residents, and 80 percent of its dental services are to that same population. Patients pay on a sliding fee basis, so there is a minimal charge that most people pay.

“With medical patients, we try the best we can, but there are more people out there who are of low income and in need of our services than we can serve, so we don’t have a good measure of how much worse it has gotten” Shea explained. “We take care of all the needs of children and pregnant women, and we take care of all emergencies for dental patients, but for many others, we are simply not able to accommodate them.”

Shea pointed out that the 2007 census figures for Kent County showed that some 51,000 county residents who did not fall into the low-income category in 2000 had joined the those ranks by 2007.

“That’s a huge increase,” Shea noted.

Saint Mary’s Health Care operates five health centers under its HealthLink banner, including: Clinica Santa Maria, which provides primary health care to the Hispanic community’s homeless, underserved and working poor; the Browning Claytor Health Center, which provides family practice services, as well as maternal, infant and lactation support services; Heartside Health Center, which cares for the homeless; Saint Mary’s Advanced Specialty Care for people with HIV; and the Sparta Health Center.

HealthLink Director Bradford Mathis said the centers are designed to be primary care “medical homes” for the underserved and the uninsured in the core city. They aren’t free health care centers, per se, but they do offer free assistance to those who qualify. Others pay on a sliding fee scale based on family income and family size in accordance with national poverty guidelines.

Each of the HealthLink sites has seen fairly significant increases in patient numbers, and the challenge is that the organization is down by three or four physicians this year, partly due to maternity leave, Mathis said. Heartside Health Center is now seeing “regulars” who previously had insurance but have lost their jobs and, subsequently, their insurance coverage a few months later.

“Overall we continue to see an increase in the demand and need for our services, particularly among new patients who recently lost their jobs and have no insurance,” Mathis said. “We absolutely try not to turn anyone away. If a person doesn’t have insurance or has limited insurance, he can apply for financial assistance. From a stewardship standpoint, if we can actually bill Medicaid or Kent Health, we can generate revenue to reinvest back into services.”

The Nursing Center of Battle Creek, which is a free clinic, is dealing with an increasing number of patients, as well. The center takes care of patients’ immediate, urgent needs and then hooks them up with a health care provider in the community, said interim Executive Director Margaret Smith. Its medical staff and volunteers assist between 250 to 290 people during the 16 days the center is open each month. Interestingly, for the past three months, 50 percent of those who have come to the Nursing Center have been insured rather than uninsured, Smith noted.

“It gives us a picture of who is going to be in need of health care,” Smith said. “Job losses are definitely on the rise.” 

Jane Zwiers, executive director of the Free Clinic of Kalamazoo, said her staff is seeing a steady increase in the number of people knocking at the clinic’s door. It’s now serving about 150 people a week. The clinic operates differently than most free clinics in the state in that it does not offer primary care. It offers diagnosis and treatment of minor and acute illnesses and emergencies, as well as dental screening to the uninsured. It also provides people who lack insurance coverage or resources with health information, advocacy and referrals.

Zwiers said what is really sad is that when people lose their jobs and subsequently their insurance, they think they can’t return to their regular doctor.

“They can go to their doctor’s office, work out a payment plan and pay by the month. We’ve tried very, very hard in Kalamazoo County to integrate the uninsured back into the health care system for ongoing care if they have an existing physician. We can still see them for their episodic urgent visits and can supplement their regular care with medication assistance, emergency dental and vision services.”

Most free or reduced-fee clinics in the state do primary care or a kind of primary care, where they take a certain number of patients in and can only take in new patients every couple of months, Zwiers said. At the free, very large Hope Clinic in Ypsilanti, for instance, people wait an average of 100 days to get in. Other clinics just take the first 25 or 30 people who walk in the door.

“It’s not the answer for the long haul: You can’t build health care for this many people in this state and in this country with volunteer-based organizations that are totally dependent on donations,” such as Free Clinic of Kalamazoo and Hope Clinic, Zwiers said. HQ

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