Two years ago, drawing on my 17 years of experience as a registered nurse and manager of a primary care office, I founded the Denton Community Health Clinic in Denton, Texas, where health services are based on a sliding fee scale. We see roughly 2,200 patients a year.
Their stories are typical of the complicated issues that arise in managing health care, particularly of those with limited means. And therein lies the problem with the Affordable Care Act, as currently structured. Having insurance without a nuanced, hands-on approach does not lead to better access to health care. Simply having insurance doesn't mean you get the right treatment and many patients with insurance have such high deductibles that they avoid seeking health care.
One of our patients has had diabetes for over 15 years. She chose to have health insurance through her employer but the plan she could afford has a $1,000 deductible. She had to pay so much out of pocket that she stopped taking care of her diabetes. When she came to our clinic her blood sugars were dangerously high. Our clinic managed to get her less expensive diabetes medications and we subsidized her office visit costs so she could be seen regularly. Because of her diabetes, she needed to see an eye specialist. After the first specialist visit, it was found that she needed more extensive testing. She came back to our clinic distressed saying that she was not going back to the eye specialist as she already owed almost $300 after the first visit and could not afford it. We again subsidized the cost of the visits to the eye specialist.
Some may say that at least having insurance will help people get preventive health that will be covered at 100 percent. Sounds great, doesn't it?
But what really happens with a chronic condition is that these newly insured have high deductibles to pay and the visits or test costs are terribly high, like in my patient's case above. They can't afford care even with insurance. Health Exchanges increase the cost to Americans but do not guarantee that individuals have access to better health care that is cost-effective.
A different type of health care is needed that focuses on individualized care. It was not the access to insurance that made the difference but rather the manner in which health care was delivered.
The Institute for Healthcare Improvement and the Agency for Healthcare Research and Quality have for many years stressed that in order to improve the health of Americans of all economic levels health care needs to be delivered in a patient-centered way that is cost-effective and of better quality.
Care like what we offer at Denton Community Health Care is centered on the individual and keeps individuals healthy in the workforce can be a model for the nation.
My clinic receives most of its funding from people in the community and some local foundation grants. We also see individuals who are insured so that when our patients have access to insurance they do not have to seek to develop a relationship with a new provider. In addition, the revenue generated from insurance fees helps support the clinic. With the extra revenue, we provide subsidies for specialized care for those who are low income or uninsured.
However, clinics like ours need funding for specialized care, like surgeries and invasive testing that is needed for cardiac problems for example. When those with low income can go to the doctor for the management of their chronic disease by paying as little as $5 per visit instead of $60 to $100 per visit, then they can be productive community members. Better yet, Americans need coverage for all levels of care that is affordable. Having access to free preventive care is simply a drop in the bucket when many of these individuals have chronic diseases that need to be managed and they cannot afford the deductibles.