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Archive for Sunday, October 27, 1991

A GROWING PROBLEM

October 27, 1991

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Judy Eyerly is eager to see the agency she directs close its doors.

Eyerly, director of Health Care Access, a non-profit agency that provides health care for Douglas County residents who can't afford it, said the agency's No. 1 goal since it opened in June 1989 has been to close.

Eyerly is looking forward to the day when there's no longer a need for the agency, which provides health care services for families and individuals with limited financial means and who are not covered by government programs or private insurance.

Although Eyerly believes Health Care Access is doing its best to serve the county's medically indigent population, she said the agency is not the solution to the health care problem. Complete reform of the health care system is, she said.

"This is just a Band-Aid," Eyerly said of the agency during a recent interview. "This is not the answer."

THE EFFECTS of the rising number of people who can't afford medical care are being felt across the state. The Kansas Department of Health and Environment estimates that between 11 percent and 17 percent 271,500 to 500,000 of the state population is medically indigent, which means they either can't afford medical care or don't have access to it. KDHE figures for Douglas County peg the medically underserved at 9,000.

Joyce Volmut, director of primary care services for KDHE, believes the number of medically indigent Kansans is going to continue increasing until "some decision is made about health insurance, looking at the cost of medical care and how it's going to be paid for."

Volmut said a major question that's being debated these days is what basic health services are and whether those services are a right entitled to everyone.

LINDA LUBINSKY, director of the Kansas Association of Home Care, said people's attitudes about health care vary. The state of Oregon, for example, is rationing health services in order to stretch state-appropriated health care dollars as far as possible.

"But then there's the other group that says how can you do that?" Lubinsky said. "It's a Catch-22."

Unfortunately, Lubinsky said, the needs of the medically indigent don't go away. If they aren't provided care initially, they probably will end up going to a hospital or institution, which is more expensive.

"It's a very ugly circle," Lubinsky said.

But as she sits on the board of the Douglas County Visiting Nurses Assn., where 17 percent to 19 percent of the budget goes toward indigent care, Lubinsky has realized what an "enormous emotional and financial burden" providing care for those who cannot afford it can be. The VNA has reported monthly deficits all year, and although the agency is inching toward the black, there has been some talk about how much longer the agency can afford to provide free care.

HOWEVER, Lubinsky said the entire home care industry is based on "autonomy, self-respect and the unwritten principle that you don't turn people away."

Echoing other health professionals, Lubinsky said it's time to do something about the nation's 30 million people who are uninsured.

"We have to keep encouraging policymakers to find some solutions," she said.

Barbara Smith, director of operations for the Bert Nash Community Mental Health Center, agrees. She said Bert Nash administrators have noticed it's getting harder and harder for people to use insurance for mental health care because of higher deductibles.

Smith said 58 percent of Bert Nash clients have annual incomes below $16,000 and 26 percent have incomes below $5,000. Smith said it's part of the center's mission to help low-income people who need mental health care, even though the past two years have been difficult on Bert Nash financially.

LUBINSKY said those who can afford medical care should try to help those who can't.

"It's incumbent on us to try to assist where we can," she said.

Health Care Access operates almost entirely on private donations. Eyerly said the number of clinic visits have increased steadily since the agency opened. In 1990, the agency's volunteer physicians and nurses staffed 862 clinic appointments. Through September of this year, Health Care Access has made 806 appointments.

In 1990, the agency allocated $10,000 for help with the cost of prescriptions. Through September of this year, $10,100 already had been allocated.

Robert Ohlen, Lawrence Memorial Hospital Executive Director, has seen charity care go up about $100,000 from 1988 to 1990. About 90 percent of the increase was caused by more people needing assistance, he said. About 10 percent, he said, came from rate increases.

FROM JAN. 1 to Sept. 30 this year, 7.49 percent of the hospital's gross revenue has gone toward services for people who cannot afford to pay, including Medicaid patients. Fifty percent of the free care occurs in the emergency room.

Ohlen guessed that all hospitals provide some free care. The percentage probably is lowest in for-profit hospitals and highest in large metropolitan areas, he said.

Ohlen said the "cost of providing that care is allocated within our rate structure. If 100 percent of the people paid, our rates would be somewhat lower than they are."

Ohlen said he'd rather see people receive medical care before they become seriously ill. Unfortunately, he said many people wait until they need to be hospitalized, which in the end costs the community more money.

MARCEIL LAUPPE, director of the VNA, said that agency is not only seeing more people who can't afford to pay for health care but sicker people who are medically indigent. Eyerly didn't have information about the types of services Health Care Access clients needed, but she said the number of laboratory and X-ray services required has increased.

In 1989, LMH wrote off $3,603 in providing those services for Health Care Access. In 1990, LMH provided $14,760 in laboratory and X-ray work, and from January through September of this year, that figure has escalated to $34,377.

Ohlen said providing the medically indigent with services initially translates into "savings for society."

Kansas Sen. Wint Winter Jr., R-Lawrence, said "it's insane" to wait for people to need to go the emergency room before providing them health care.

Winter said he believes that everyone has the right to basic health services, which range from immunizations for children to better care in nursing homes. He said the state and nation's budget problems largely are due to the health care system.

"IT'S ABSOLUTELY eating us out of house and home," Winter said.

Winter said "it's absolutely absurd that we spend more on health care than any other country yet rank last among industrialized countries in quality of health care. Taxpayers are paying far too much for far too little."

Last legislative session, Winter co-sponsored a bill calling for universal health insurance coverage for Kansans. The measure would create a single pool of insurance financing through a new tax. Instead of paying insurance premiums, Kansans would pay a tax that would ensure basic health services "from the homeless waif under the bridge to the president of KPL.''

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