The Gaps in Health Care (1)


March 30, 2016
By Imaz Athar

Physicians are polarizing figures. If they do right, successfully treat an ailment or discover a brand new therapy, we view them as our ultimate medical healers. On the other hand, if the treatment our physician provides is ineffective, we’d want nothing more than to revoke their undeserved medical license and take back the hours we wasted in the waiting room. As someone who aspires to be physician, I like to explore how we view the field. It’s nice to dwell in the good, but it’s also instructive to look at the not-so-good; I put myself in the physician’s shoes and ask “how can I be better?”

The truth is that physicians can have an extraordinary influence on one’s life—it’s almost overwhelming to think about. Of course, the physician deals with the physical and mental health issues that plague their patients’ lives. But, often times, patients face social and financial insecurities, as well. This whole new world of problems are strongly linked to health because they affect the health care that patients are able to receive. While many physicians are aware of these problems, they don’t quite have the education to address them, leaving many patients underserved. My experience as a fellow at South Side’s Birmingham Free Clinic helped me realize this.

I’ve been a fellow for Pittsburgh’s Birmingham Free Clinic’s Health Links program for over a year now. The Birmingham Free Clinic is the result of a partnership between the Salvation Army and the University of Pittsburgh’s Program for Health Care to Underserved Populations. Part of the clinic’s mission is to provide health care. Five days a week, a volunteer group of physicians, nurses, and other clinicians provide free primary and acute care, physical exams, vaccines, and consult services to uninsured individuals who are vulnerable to falling through the gaps. In addition to providing free health care, the Birmingham Free Clinic also recognizes the social and financial issues (which I mentioned earlier) that affect their patients. Some of the patients that come to the clinic may need help looking for employment, food, rental assistance, or new furniture, among other things. That’s where myself and the other Health Links fellows come in. We meet with patients at the clinic one-on-one, find out what needs they would like addressed, and then work with them to find organizations and services to help meet their needs.

This past Summer, I was seeing a patient (let’s call him John) who needed help paying his medical bills. John was uninsured and was suffering from a mental illness. He had visited the Birmingham Clinic in the past but, after an emergency, he received treatment from a hospital. The treatment seemed to help John, but the amount of money it cost was both astonishing and unexpected. John found out that we would have to pay thousands of dollars in medical bills, putting him in an even greater hole than the one he started in.

John isn’t alone when it comes to this problem. According to a recent Gallup poll, 11.4% of individuals in the United States are uninsured. This number is steadily decreasing, likely due to the implementation of the Affordable Care Act. Nonetheless, even under the ACA, many are still uninsured due to the high costs of coverage. In 2014, 48% of uninsured individuals cited costs as a major reason they were uninsured. Also, many remain uninsured in states that haven’t expanded Medicaid (a health care program for low income individuals) due to the high costs of public insurance. Without health insurance, John and others seek treatment at clinics like the Birmingham Free Clinic. Otherwise, they can seek treatment at a hospital and risk falling into huge debt—according to a recent study, many hospitals in the U.S. charge the uninsured 10 times the cost of care. Studies have also shown that the same group of low income, uninsured individuals are also those that are the most vulnerable to poor health. With that said, a clear and unfortunate disparity exists. Those that need health care the most face the greatest barriers to accessing it.

As a fellow, where do you start with a case like John’s? There are a few organizations that provide small grants to help individuals pay for medical bills. These grants often require an application process, paperwork, and a wait time. It’s stressful enough to be in thousands of dollars of debt, and I can only imagine how mentally taxing it is to have to wait. Some applications also require a permanent address. At the time, John didn’t have a permanent address—instead, he was living with a friend. So, rather than looking at the small grants, I started to talk to John about applying to Medicaid. Well, it turns out that you need a permanent address to apply to Medicaid too, which only further complicated things for John.

Some hospitals provide financial assistance programs to patients like John who are having trouble paying medical bills. But, there’s another complication. To apply to financial assistance, you need a letter that explains that you aren’t eligible for Medicaid. Not only would this entire process take a lot of time, but it’s also difficult for John because he can’t apply to Medicaid to begin with. John is just one of many in the U.S. that are already slipping through the cracks because they’re uninsured. To make matters worse, the current system further complicates things so that people like John fall through the gaps and end up in a tangled web of paperwork, paperwork, and more paperwork. Our system has created what seems to be a hopeless situation for many. This is something that we absolutely need to change, and I’ve only realized this through my experiences as a fellow.

Treating a patient is more than remedying an ailment and providing medication. In many ways, it seems that doctors need to have the mind of both a physician and a social worker—physicians need to gain a better understanding of the patients they treat, as well as the workings of the health care system that affects them and complicates treatment for many. Physicians have a voice that others will listen to. It’s important for physicians to take advantage of that and advocate for the underrepresented because, often times, these are the individuals that need treatment the most. Ultimately, the physician’s power isn’t necessarily in healing wounds. Instead it’s in establishing a connection with the patient. In today’s age, it’s very easy to be cynical about the shortcomings of our healthcare system, and it can be extremely difficult to rise above it. But, it’s important that physicians do. There are so many individuals falling through the gaps of our healthcare system. It’s not only important for future physicians to realize them, but it’s imperative that they work to close them too

Read part 2 here.



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