Posted January 24, 2007

Bigger role for city clinics

Editorial Opinion by Brady Russell

IF YOU'D been with me outside city Health Center 6 at 7 a.m. on Friday, you'd have seen why we need to staff up our clinics.

I go early to visit with people waiting in line to get in when the clinic opens around 8. Most of the time, I meet 10 to 20 people who got up early to wait in the cold - and it's plenty cold in Philadelphia before sunup these days.

When uninsured people in the city get up and realize they're sick or in pain and have to see a doctor right away, they stand in line and wait for a health center to open. They know that if you aren't in line for a walk-in before a clinic opens, you're not going to be seen.

Last week, when Gov. Rendell unveiled his plan for extending health coverage to the 770,000 Pennsylvanians without it (140,000 live in our city), he spoke of all the adults who lack a "medical home." The working poor don't have a place to go when they're worried something might be wrong. They know that quality care is available at our health centers, but getting in is very hard.

Say your feet hurt or you feel a lump under your neck. Those aren't emergencies, so you generally can't get seen at a hospital. If you want to go to a city health center, you'll have to burn half a day, and part of a paycheck. Private doctors probably just won't see you without insurance.

So you get up at 5:30 and make your way to the health center in the cold and dark. At least you don't have to worry about safety while you wait outside the health center, because you won't be alone. When I show up and talk to people, they aren't happy but they need to be seen.

A lot of them are missing work. Three-quarters of the uninsured in our state are employed, so the health centers need the resources to expand their hours into the evening, open on Saturdays and get staffed to the point that they can be used to their full capacity. The money to accomplish a lot of this is there, the city just needs to get moving on hiring.

Gov. Rendell recognizes the problem of getting health care after hours when you don't have an emergency. He's calling for all hospitals to open urgent care facilities for people with serious but non-life-threatening medical issues. People who need a few stitches, an injection or maybe a simple prescription. We agree.

Except I can't help but think there's already enough going on in the city's hospitals.

We already have nearly 30 sites operated by "federally qualified health centers," including those operated by the city. If hospitals become required to support urgent-care units, our city might be positioned to do one better for the same cost: create partnerships between qualified health centers and hospitals so that urgent care can run in them around-the-clock as well as providing the resources for evening and weekend hours for primary care at these sites.

AFTER ALL, why should hospitals build new floor space to house urgent care when we already have lots of medical facilities that sit empty after hours?

Whatever it takes, the many uninsured members of my organization feel encouraged by the governor's commitment to extend health coverage to everyone.

We also know this is going to be a hard fight. If it's won, we must make sure there's expanded health-care capacity to meet the demand created by thousands more people who can actually afford to see a doctor. If it doesn't succeed, the city's district health centers are the best protection our uninsured have against small problems getting worse and keeping them from working.

So, either way, the city should use the nearly $2 million it already has to hire up at the health centers and plan to expanding their hours into evenings and Saturdays. Then folks can get in for appointments at a reasonable time by heading over after work for a walk-in with a reasonable expectation to be seen.

Sick people shouldn't have to wait out in the cold.