The Care of the Uninsured in America PDF
Preview The Care of the Uninsured in America
The Care of the Uninsured in America Nancy J. Johnson Lane P. Johnson ● Editors The Care of the Uninsured in America Editors Nancy J. Johnson Lane P. Johnson El Rio Community Health Center Arizona Health Science Center Tucson, AZ Tucson, AZ USA USA [email protected] [email protected] ISBN 978-0-387-78307-9 e-ISBN 978-0-387-78309-3 DOI 10.1007/978-0-387-78309-3 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2009930644 © Springer Science+Business Media, LLC 2010 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To Our Patients Preface As the director of a Faith Based Community Health Center, I daily find myself interacting with medically uninsured patients and their families. At our clinic, we are blessed with wonderful staff and volunteers. We make a significant difference in the lives of the people we serve, and I have learned that the effort also makes a significant difference in the lives of our staff and volunteers. As I interact each day with our patients and their families, I come away recog- nizing that there is no individual face of poverty. Having lived my adult life rela- tively well off financially, I am struck with how many of our patients look like my friends and neighbors; that there is no particular ethnicity or age. Our patients look pretty much like the rest of us. The sobering fact is how close to the truth that may be. The difficulty of being medically uninsured is only the tip of the iceberg. Many Americans are only a few paychecks away from homelessness, and less than that to lose (if they ever had) their medical insurance. For most of our patients, it is not about choice, it is about circum- stance. Joblessness, homelessness, accident or illness, advancing age, disability, and mental illness are all merely predisposing factors. Every day at our clinic, we count our blessings and realize how fortunate we are to be able to provide health services, and that it is a fine line to cross and find one’s self in need of health services. The least we can provide is respect and caring, and we strive for that with every interaction. It is not always easy, but respect and compassion are the real foundation of a medical home. As we have come to work with other organizations in our communities to address the larger problems of the medically uninsured, we recognized that there were few resources to help us figure out what the issues are, and how we might go about trying to resolve them. Practically every community in the United States has to address these issues. Rather than continuing to reinvent the wheel, we have compiled this book as a collection of thoughts and ideas that may help get you started. Bless you for your compassion and caring. Let us all move forward together. Nancy J. Johnson, RN, PhD(c) Executive Director El Rio Community Health Center Tucson, AZ, USA vii Preface As a physician, I have been trained to take care of each person’s medical issues as I see them, and consider the ethnic, cultural, economic, and demographic issues primarily as they relate to the medical concerns. Even though my career has been focused on the medically underserved. Even though I have a degree in public health, and despite what I teach my students. What the editing of this book has reminded me is how important it is to consider our patients collectively if we are going to be effective in the long run. We can take care of patients through our days, our years, our entire careers, and still not affect the system that helps to perpetuate the conditions in which our patients find themselves. As a physician, one learns to compartmentalize, and at times this is a useful strategy in taking care of patients. But it allows us to too easily separate ourselves from our patients and their conditions, to think of them and us. There are very few of us in the United States who are far away from the possibil- ity of no medical coverage. That we are the only developed country that is in this position, and over 25% of our residents are without any medical coverage insur- ance, is shameful. It is about us, and we all must do more to correct these inequities. There are sufficient resources in this country to accomplish the goal of health care for everyone. What we lack as a country is sufficient political will. Some other lessons I have learned or been reminded of in this editing process: What we have written is a snapshot in time. The past influences the future, but we cannot dwell on it. We have to consider what the most effective means are to provide care to the medically uninsured, and move forward. Among medically uninsured populations, the diversity is as significant as the commonalities. There is no single fix. Regardless of a patient’s background, the single most important tool we have in taking care of the medically uninsured is the development of a medical “home” which patients can identify as the place they can come to get care. What is a medi- cal home? Nancy said it best. Where you are respected and cared for as the person you are, not the circumstances that have placed you in the position you are in. I am convinced it is from this concept that a viable system can be developed. ix x Preface As Dr. Cullen’s chapter on information technology points out, what is required is not just a new electronic system that follows the patients, but a new language that creates and defines a system that can appropriately care for the patient. What we design for the complexities of caring for the medically underserved can serve as model for caring for everyone in this country. Many innovative, bold, and wonderful solutions have been developed as local/ regional models. As communities and states we can learn from, and support, each other. But the local models are not, by and large, self-sustaining. Ultimately, solu- tions to the lack of medical insurance in this country will require a national perspec- tive, and federal funding. That is part of the work we all must do, and Dr. Dalen’s chapter points out some of the possibilities and pitfalls other countries have experienced. When I wonder how the system we have hasn’t already collapsed from its own weight, I just need to look at the people working within it. Healthcare is a service industry, and we have been blessed with professionals who understand and live the concept of service in their daily lives, who go the extra mile for the patient despite the vagaries, the barriers, and the sometimes mean spiritedness of the organiza- tional infrastructure. At times I look at the ascending generation and wonder if they have the heart, the vision, the courage, the resolve, and the tenacity to even continue to try to weave new thread in this patchwork quilt of a healthcare system. But then I look at the young workers at Nancy’s clinic, or my own students, and my heart is filled again with hope. Lane P. Johnson, MD, MPH Associate Professor, Clinical Family and Community Medicine Associate Clinical, Professor, Mel and Enid Zuckerman Arizona College of Public Health Arizona Health Sciences Center Tucson, AZ, USA Contents Who Are the Uninsured? ................................................................................. 1 Howard Eng Why Are People Uninsured? ........................................................................... 21 Nancy J. Johnson The Culture of Poverty and the Uninsured ................................................... 35 Nancy Johnson Health Disparities and the Uninsured ............................................................ 45 Nancy J. Johnson Providers of Care for the Uninsured .............................................................. 63 Nancy J. Johnson Chronic Disease and the Uninsured ............................................................... 87 Nancy J. Johnson Medical Homes ( preferably “Health Home”) and the Uninsured ................ 109 Nancy J. Johnson Medication Assistance for the Uninsured ...................................................... 129 Nancy J. Johnson and Janet S. Smith Medically Uninsured Refugees and Immigrants ........................................... 145 Lane P. Johnson Medically Uninsured and the Homeless ......................................................... 153 Jennifer Vanderleest Care of Underserved People with Mental Illness .......................................... 161 Francisco A. Moreno and Sarah Heron xi xii Contents Medically Uninsured Older Americans ......................................................... 171 Lynne Tomasa Direct Caregivers Association: An Option for a Rapidly Growing Aging Population? ............................................................................ 187 Judith B. Clinco The Rural Uninsured ....................................................................................... 195 Lane P. Johnson Dental Care for the Uninsured ........................................................................ 205 Lane P. Johnson Uninsured Children at School ......................................................................... 217 Fran Bartholomeaux and Nancy J. Johnson Building Community Collaborations Around Care for the Uninsured ...... 231 Nancy J. Johnson Information Technology and Medically Uninsured ...................................... 243 Theresa Cullen The Role of Government in Providing Health Care to the Uninsured ........ 259 James E. Dalen Think Nationally, Act Locally ......................................................................... 271 Lane P. Johnson Index .................................................................................................................. 279
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