An endless wait for health carePoor, uninsured face long line for medical services
Sunday, December 25, 2005
by Judith Graham
Brenda Yonzon was thrust into Chicago's public health system last year when her husband died suddenly, leaving her without private health insurance.
There, she discovered a different world.
As a private, insured patient, Yonzon could call her longtime doctors a nd get an appointment the next day. As an uninsured public patient, she waited eight hours at Stroger Hospital before even seeing a physician who would attend to her kidney stones.
Before, Yonzon could go to a pharmacy and pick up a prescription in 15 minutes. At Stroger, Yonzon stood in line for hours only to have a woman at the counter say the prescription wasn't ready and she would have to come back another day.
"That was agony," said Yonzon, 58, who has diabetes and hypertension.
Such stark differences in medical care for the uninsured aren't new. But the rising tide of Americans without health insurance, combined with medical costs that outpace the rate of inflation, is increasingly straining public hospitals and clinics that serve the needy.
That means the problems Yonzon experienced are getting worse, resulting in even longer waits for service and reduced access to care.
"Back in the old days, the safety net wasn't so overwhelmed," said Dr. James Webster, president of Chicago's Board of Health and a geriatrician at Northwestern Memorial Hospital.
While the medical care in Cook County's health system is generally acknowledged to be excellent, it's getting harder for patients to obtain it.
In the last year, the Bureau of Health Services has closed clinics for diabetes and glaucoma to new patients because it can't accommodate the demand for services.
Colon screenings, recommended for all Americans over age 50, are largely unavailable to poor and uninsured county residents. Non-urgent surgeries are increasingly difficult to schedule. Prescriptions take days, not hours, to fill.
The developments mean that more people are putting their names on waiting lists, going without medical care or delaying trying to get services until they are in an acute crisis.
Webster sums up the problem this way: "If you have good insurance or you're wealthy, you can have all the medical bells and whistles tha t you want. If you're uninsured, you're at the mercy of the system, and the best you can hope for is standing in line forever."
Medical advances contribute to the problem, he said. Today's doctors can do more for sick patients, increasing demand for services.
The trend is national; signs of a similarly overwhelmed system for the uninsured are evident in most major urban centers, from Los Angeles to Atlanta. Uninsured patients in rural America are also hard hit. With fewer doctors, smaller hospitals and no formal charity care networks, rural residents often encounter significant difficulties getting medical attention and incur large bills in the case of a medical crisis.
In all, some 45.8 million Americans are uninsured, including 1.8 million in Illinois.
Cook County's Bureau of Health Services, which runs Stroger, Oak Forest and Provident Hospitals and 28 community clinics, is feeling the strain throughout its delivery system, one of the largest public health networks in the nation.
Two years ago, for instance, the new Stroger Hospital opened with a capacity of nearly 80,000 emergency room visits a year. But in the 12 months ending Nov. 30, visits to the ER totaled 155,000.
Rising demand for care from people who have no means to pay is "taxing our services tremendously" and leading to increasingly long waits for care, said Dr. Daniel Winship, chief of the Health Services Bureau.
Specialty clinics are so overburdened that it now takes 14 months to get an appointment with a gastroenterologist and 7 months for an appointment with an orthopedic physician, Winship reports. Surgical services are so swamped that the county is declining to schedule appointments for non-urgent procedures such as gall bladder surgery or hernia repairs unless patients are in a state of crisis.
At some primary care clinics, doors have been shut to new patients except for children and pregnant women, Winship said. Lines are getting longer at those that remain open. At the Cicero clinic, for example, the waiting list for an appointment now totals 800 patients.
Inefficiencies in the health bureau may contribute to these difficulties, critics suggest, and resources may need to be reallocated.
But there's little doubt that demand for care from those who can't afford to pay keeps rising.
The situation is so dire that the Cook County health system is considering shutting off access to patients who come from other areas, something it's never done before. "We're getting to the point where we have to look at doing things differently," Winship said. About 5 percent of the system's patients live outside Cook County, with the majority coming from the collar counties, where there is no comparable delivery system for poor and uninsured patients.
Also affecting care for uninsured and poor patients are the widening differences between medical institutions in affluent communities and those in disad vantaged communities, according to research published in this month's issue of the policy journal Health Affairs.
In their review of 12 communities--Boston, Miami, Cleveland, Indianapolis, Phoenix, Seattle and others--the authors found that hospitals in wealthy areas invest heavily in the latest medical technology and services, while those in poor neighborhoods cannot do the same.
"Notable advances in technological capacity, clinical performance and administrative ingenuity found in parts of the health care system are not being evenly distributed, because of a growing inability or unwillingness to ensure equal access to high-quality care," wrote the authors, led by Robert Hurley, an associate professor of health administration at Virginia Commonwealth University.
An unpublished study by the Metropolitan Chicago Healthcare Council came up with "largely the same conclusions" a few years ago, said Dr. Lawrence Haspel, the organization's senior vice president. The st udy found that poor Chicago-area hospitals find it harder to keep up with medical advances and that these differences contribute to a growing gap between the medically well-off and the medically disadvantaged.
"This is an unsustainable system," said Haspel, citing rapidly rising medical costs and more employers dropping insurance coverage.
Gloria Jean Sykes, who lives on the Northwest Side of Chicago, first found herself relying on Cook County's health care services in early 2003, after unexpectedly losing her medical coverage in a dispute with her insurance company over late premium payments. Sykes had been diagnosed with breast cancer and had a lumpectomy a year earlier.
It was already a troubled time financially for this freelance writer and producer. She turned to Stroger's breast cancer center for discounted care.
"I get there at 8 a.m., and by 11 a.m. no one has talked to me yet," said Sykes, 53. "I kept going up and complaining until they calle d me back to an examining room. There a doctor says, `Gloria, we will give you the best care you'll ever receive but you're no longer in the insurance world and you'll have to wait your turn.'
"At first, I was shocked. But you become very humble and thankful this option exists," said Sykes, who last year found a job selling advertising and had medical coverage again briefly before the company went out of business. Today, she pays $500 a month to continue that coverage under COBRA, or the Consolidated Omnibus Budget Reconciliation Act, but will become uninsured again when the policy ends next year.
Sykes now splits her care between Stroger and Advocate Lutheran General Hospital in Park Ridge. "Unless you're Donald Trump or Martha Stewart," she said, "the reality is what happened to me could happen to you."