The Way I See It: Some doctors welcome the uninsured

March 21, 2008

Some doctors are glad to treat the uninsured.

People who don't have health coverage are often uninsured for a reason. Perhaps they're homeless or they've lost their job. Perhaps they have psychiatric problems or abuse alcohol or drugs. Some are new immigrants. Others are hard-working Americans whose employers either don't offer health insurance or offer inadequate coverage that their employees can't afford to supplement.

Whatever the case, you may offer such people free care out of a sense of compassion, duty, altruism, or something else. I applaud your effort, which is almost certainly costing you revenue. But, given the often-serious problems of the uninsured and the US healthcare system, the patient care you're providing is likely to be fragmented and inadequate.

I have a better idea: Refer these patients to another physician-someone who has the resources necessary to meet their needs. Someone like me.

How can my colleagues and I provide care to the poor and uninsured more effectively than you can? First, we have the funding to do the job, or at least more of the funding than most. It comes from supportive county commissioners, a portion of a social services tax, and generous contributions from hospital board and community members. Second, we have a system that assesses patients' ability to pay on a sliding scale of 1 to 6.

Patients rated 6 qualify for free doctor visits, labs, testing, and hospitalization. If necessary, I can also refer them, again free of charge, to a full array of specialists. They pay $5 for most prescription medications, thanks to an arrangement our pharmacy department has with several drugmakers. And if even this amount proves too costly, a social worker helps them apply for further drug company assistance as well as any community services they need.

We can also provide skilled nursing services or home healthcare for newly discharged patients, place those with psychiatric or substance abuse disorders in appropriate treatment programs, and even arrange for transportation to and from our clinics. For the uninsured, all of this is free.

Can you provide this range of services? Most practices-indeed, most hospitals-can't.

That's why I urge you to take this seriously. Sure, you want the best care for all patients, including those who are uninsured. But, unless you can give such patients the full care they deserve, you shouldn't be the one providing it.

Instead, refer your uninsured patients to those who can provide the best care. And think about volunteering a portion of your time to help out programs like mine. If they don't exist in your community, think seriously about spearheading an effort to create them.

Without the resources, you shouldn't be caring for the uninsured-you just need to be helping those of us who do.