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Archive for Tuesday, March 4, 1997

CLINIC SERVES UNINSURED

March 4, 1997

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A study shows Health Care Access decreases the number of uninsured patients who visit hospital emergency rooms.

With the number of uninsured Kansans steadily rising in the past seven years, a similar increase in the number of uninsured patients at Lawrence Memorial Hospital's emergency room would be expected.

But thanks to Health Care Access, that isn't happening. In fact, a dissertation shows that the number of uninsured patients at LMH's emergency room has dropped 63 percent in recent years.

Betty Smith-Campbell, a founding member of Health Care Access, successfully defended the dissertation for a Ph.D. in Nursing from the University of Colorado. Smith-Campbell, who started a task force that studied health care in Lawrence in the 1980s, was a board member for Health Care Access from 1989, when it was formed, to 1992.

According to her findings, based on information from LMH, the number of emergency room visits at the hospital not covered by insurance went from 4,378 in 1993 to 2,678 in 1995.

"It's really interesting from a statistical point of view that visits (by uninsured people went down) but the number of uninsured people across the nation went up," said Smith-Campbell, who is now an assistant dean at the Kansas University School of Nursing. "There are more than 40 million uninsured people in the United States now, and the 1990 Census shows that there were 37 million uninsured people then."

The state doesn't keep exact figures on the number of uninsured people in Kansas, but the Kansas Department of Health and Environment roughly estimates that 10 to 15 percent -- between 248,000 and 371,000 people based on 1990 Census figures -- fit into that category. The number of employers across the nation offering insurance is also dropping, from 61.4 percent in 1989 to 56.6 percent in 1995, according to the American Hospital Assn.

Volunteering skills

Since 1989, Health Care Access has provided primary medical care to uninsured people who make no more than 150 percent of the poverty level set by the federal government, said the clinic's executive director, Carol Stambaugh. That figure will drop to 130 percent this year, Stambaugh said. Based on 1996 poverty numbers, a single adult would be offered care this year if he or she makes no more than $838.50 a month; a family of four would be eligible up to $1,690 a month.

Nurse practitioners treat most of the patients, but local dentists and doctors volunteer for more serious cases. Patients with emergencies are sent to LMH, but Smith-Campbell's data show some of those visits are avoided by earlier treatment at Health Care Access.

LMH supplies laboratory tests and X-rays at reduced costs, and a majority of Lawrence pharmacists sell medicine to Health Care Access patients at wholesale costs.

"If a patient goes to Health Care Access and is treated for their condition, such as diabetes, that prevents them from going to the hospital for a more costly procedure in a crisis situation," Smith-Campbell said.

Judy Eyerly, who was executive director of Health Care Access until 1996, said physicians and doctors involved with the organization knew it was keeping some patients from the emergency room.

"I think the real exciting thing about what she's done is that it confirms what we have known anecdotally," said Eyerly, who works for the Kansas Association for the Medically Underserved. "It would be great to duplicate that study across the state at similar clinics."

Expanding care

The state started sending money to clinics that serve uninsured patients beginning in 1992. Stambaugh said last year's budget of $189,000 included $128,000 from the state. Grants, fund raisers, local funds and client fees -- office visits are $10 and referrals to specialists are $5 -- also make up the budget. Stambaugh said the United Way contributed $13,363 in 1996.

The state and local money has allowed the clinic to expand its hours. When it first opened, the clinic was open only four hours a week. Now it is open weekdays. In 1989, there were 324 office visits; in 1995, there were 4,237. There were 4,275 office visits in 1996.

"I think our state legislators should be proud because this is one funding policy that really makes a difference in a community," Smith-Campbell said. "The community needs to be proud because not only do we have help from the hospital, but we have nurses and physicians and dentists who also put in time and services to support this."

Surveys also showed a high rate of satisfaction among patients who visited Health Care Access, Smith-Campbell said.

"When asked where would they go if Health Care Access didn't exist, several said they would have nowhere to go for care," she said.

About 70 percent of the people treated at the clinic have jobs and aren't receiving assistance such as welfare, Stambaugh said.

"I think this affects the community in a huge way this is sometimes not easy to see," she said. "When the working poor are sick, they are at a much greater risk of losing their job or a day's pay, because a lot of minimum wage workers don't have health benefits.

"If you look at the larger picture, I think there's a huge impact we have have on the community."

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