It is conventional wisdom that a fence at the top of a cliff is better than an ambulance at the bottom. The U.S. health-care system, however, seems to be waiting in the ambulance. Shortsighted efforts to save a relatively small amount on upfront health-care costs have led to spending far larger amounts in the long term — not to mention worse health outcomes for patients. In response to this problem, students at medical schools around the country have mobilized in an attempt to contribute to the safety net being held in place for those who fall through the ubiquitous cracks in the U.S. health-care system.
This November marks the first anniversary of the HAVEN Free Clinic. We are a health-care clinic run by Yale health profession students out of the Fair Haven Community Health Care Center, providing free primary care, free or low-cost medications, and social services assistance to uninsured Fair Haven residents. Our experiences with the clinic have brought into sharp focus for us the many barriers to the health-care system faced by those who cannot purchase private insurance and the consequences of thoes barriers for patients and the system at large.
According to recent figure, there are 46 million uninsured individuals currently in the United States. In Connecticut, it is estimated that at least 12 percent of the population lacks health insurance, and even those who are insured by public programs such as Medicaid may find access to care elusive. The critical safety net providing health care for the uninsured and underinsured is made up of privately and publicly funded community clinics. The argument is often made that the medically indigent actually do have access to health care — isn’t that exactly what community health-care centers and free clinics are for? This idea holds quite nicely — until someone actually gets sick. Medications, diagnostics, procedures, specialty care and hospital visits are generally beyond the scope of what is provided for free by a basic primary-care facility, and a majority of the patients served by community health centers and free clinics are simply unable to afford such “luxuries.” Additionally, these organizations suffer from a chronic mismatch between supply and demand, and hospital emergency departments have become the default health-care option for many of the uninsured.
This situation is disastrous for several reasons. Compared to insured individuals, uninsured patients are far more likely to postpone seeking medical care, particularly preventative care, and much less likely to fill prescriptions for medications. As a result, they end up in the emergency room with what should have been a relatively uncomplicated and inexpensively treatable problem, which now has ballooned into a more advanced condition that is medically complex and expensive to treat. In addition, there is an influx of patients into already overtaxed emergency departments who are not actually having a medical emergency — they just have no where else to go to get care. These patients ultimately cannot pay the enormous medical expenses often incurred for these visits, forcing hospitals to absorb these avoidable costs.
Hospitals and medical schools are increasingly responsive to this issue. Yale-New Haven Hospital has been a key supporter of the HAVEN Free Clinic, donating diagnostics such as the blood tests and radiology services that are critical to providing quality care. Several hospitals in the Midwest have started preliminary programs that provide free primary care to uninsured patients with chronic conditions such as diabetes. There is also an increasing number of medical schools around the country whose students and faculty run free clinics. Still, the vast majority of the uninsured lack access to a consistent source of comprehensive health care, and much, much more needs to be done.
Providing free comprehensive primary care to the uninsured is not just good humanitarianism; it is smart economics. More institutions need to realize that when it comes to the proverbial cliffs of health care, good fences do make good neighbors.
Sara Crager is an M.D.-Ph.D. candidate at the School of Medicine.