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By Mark Guidry
Special to The Daily News
Published May 8, 2010
There are many unanswered questions about how health care insurance reform will impact Galveston County.
Will there be shifts in where residents obtain health care?
Does our local community have the capacity to care for all the newly insured?
Will there be changes in health care insurance payments?
Will insurance payments increase revenue of the 4C’s clinics and expand primary care services?
What will be the impact of the immediate changes in 2010 and those changes scheduled through 2014?
Will there be a need for existing grant programs for the indigent and uninsured (e.g., state-funded breast cancer screening programs and related immunizations programs)?
Will there be a need for county indigent programs in Texas?
While there are many unanswered questions about the new law, the mere prospect of many residents in Galveston County moving from uninsured to insured certainly is promising news for the health of our community.
With the post-Hurricane Ike changes in access to specialty and hospital care in Galveston County, most non-indigent uninsured people (above 100 percent of the federal poverty level) now face inadequate health care and no clear pathway to specialty and hospital care.
While primary care is available in the county’s two federally qualified health centers (i.e., 4C’s Clinics), when uninsured 4C’s patients need a referral to a specialist, access is a serious problem and, most often, nonexistent.
As a result, the health conditions of such 4C’s patients worsen to the point of needing care in local emergency rooms — the most costly care available in our health care system. Uncompensated emergency room and hospital care contributes to escalating health care inflation impacting all.
Besides access and cost problems, the current health care system is predominately providing more-costly “sick care,” rather than less-costly “wellness care.” If reform results in many more residents having insurance, our local health system must be prepared to provide preventive (wellness) care, primary care and specialty care to the newly insured in order to reduce the burden on emergency rooms and hospitals.
Sicknesses with pain and obvious disorders are great motivators to seeking health care, yet conditions that might be subtle or invisible are subject to being ignored — such as many early and asymptomatic cancers, diabetes and other health conditions. This results in delayed diagnosis and treatments and later, more advanced conditions requiring more costly care.
Our capacity to meet the “wellness care” needs of the newly insured residents is a concern. Many uninsured residents might not seek wellness care, such as preventive checks for high blood pressure, diabetes, mammograms, etc., since they might fear inability to pay for the drugs and treatments needed if a problem is discovered.
Once insured, many more could begin seeking such care, which allows for early diagnosis and treatments, with less fear of not being able to afford necessary treatments.
Finally, the new Patient Protection and Affordable Care Act contains provisions for $11 billion in new funding for community health centers, like the 4C’s clinics, to expand their capacity to deliver primary care and related outpatient dental and mental health services to newly insured citizens.
Other provisions would strengthen the ability of the health district to assure food safety to detect and stop outbreaks of diseases (e.g., H1N1 influenza) and to help promote healthier, informed choices about what to eat and where to exercise.
Other provisions create a Prevention and Public Health Fund, Public Health Workforce Recruitment and Retention Programs and grants to improve surveillance and response to infectious diseases and other conditions of public health importance.
One provision, for example, calls upon chain restaurants with more than 20 units to include calorie counts on their menus.
In summary, while many questions remain about the new law, the provisions for public health and health care are significant and promising. Public health services are essential to not only improving access to care and health outcomes but also play a supportive role for a healthier work force, economy and quality of life.
Dr. Harlan “Mark” Guidry is chief executive officer of the Galveston County Health District and the Galveston County Health Authority.
As published in the Galveston County Daily News. |
