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Provider Perspectives
Current System Not Working for Patients or Providers
Dr. Henley is Chair of Community Medicine at UIC Rockford and sees patients one day a week at a student teaching office. In addition, he is the medical director of the county ‘s jail health program and a medical consultant to the Winnebago County Health Department. With all this experience, Dr. Henley can empathize with the problems faced by both patients and providers in our current system. So many people cannot afford the treatment they need and doctors cannot always afford to help. Even when doctors take on uninsured and underinsured patients, the assistance they need is often beyond the scope of what the doctor can provide.
For patients, access to needed care usually depends on having insurance. Uninsured people simply cannot afford to get very sick, especially if this requires hospitalization or chronic care. For instance, Dr. Henley is currently treating a relatively young man who has experienced renal failure and needs to see a kidney specialist. However, the bills for all the treatment this man needs will be thousands and thousands of dollars. There is no way he can afford this out of pocket. Dr. Henley is prepared to advocate for his patient — he feels he may be able to negotiate with a specialist for a special rate. However, even if he is successful, he will have to start the process all over again with the labs and other facilities involved in treatment.
In the meantime, Dr. Henley has been able to prescribe some relatively low-cost generic medication for the young man. Unfortunately, this is not an option in all cases. Sometimes even the generic version of a drug is extremely costly. Other times, only brand name drugs are available. When that occurs, sometimes doctors can give patients samples of drugs or connect them with a pharmaceutical company’s patient assistance program. However, that means extra work for doctors because clinics usually don’t have the money to hire staff to do this. If these measures are unsuccessful, there may be serious medical consequences for the patients. As Dr. Henley reports, “There is good data to show the patients cut back on meds when they don’t have insurance.”
However, just having insurance isn’t enough. People with certain types of insurance still have problems paying for health care or finding providers. Dr. Henley points out that care is often unaffordable for those with high deductible or limited coverage plans. He worries about those seniors that fall in the Medicare prescription drug “donut hole.” Like his uninsured patients, they will often try to stretch medication or forgo it altogether. He also points out that there are problems with Medicaid in Illinois. While it has a good benefit package, Medicaid has historically been undermanaged and underfunded. For this reason, many providers won’t take Medicaid patients. Dr. Henley feels that with the creation of All Kids this administration has improved Medicaid, but more work needs to be done.
Health care providers suffer when a large number of patients are uninsured or underinsured as is the case in Illinois. Taking these patients on is an economic hardship, and according to Dr. Henley, the situation has gotten pretty desperate. Many primary care physicians are “struggling to survive.” They try to work with patients, but there is only so much they can do. Some primary care physicians choose to leave the field, and fewer new doctors are entering it. And who can blame them? After medical school, graduates are left with an enormous amount of debt and do not want to worry about not being paid when they are practicing. This in turn impacts patients — fewer doctors only exacerbates the problem of access to care.
Governor Blagojevich’s plan, Illinois Covered, attempts to address many of these issues. First, it proposes a loan repayment program for doctors that choose to work in underserved areas. Secondly, Illinois Covered will make an additional $1.7 billion available to providers through new coverage for the uninsured and increased rates for providers. Expanding the number of people with health insurance would allow more people to get the treatment they deserve and alleviate the burden placed on doctors and hospitals by uncompensated care. Increased reimbursement rates and a quicker turnaround time on payments would give doctors the incentive they need to take on more patients with Medicaid. If legislation is passed, and it makes good on these promises, it will go a long way towards addressing many of the problems in our broken health care system. Personally, Dr. Henly is taking a wait and see attitude about the implementation of the plan, but calls this step forward, “a good thing.”
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