Access to care
Eli Saslow, The Washington Post, September 28
Until recently, Ed Garner, was the only working doctor left to care for three remote counties east of El Paso, an area similar in size to the entire state of Maryland, home to far-flung oil encampments, a desolate stretch of interstate, communities of drifters living off the electric grid, and highway towns made up of truck stops and budget motels. In the medical desert that has become rural America, nothing is more basic or more essential than access to doctors, but they are increasingly difficult to find. The federal government now designates nearly 80 percent of rural America as “medically underserved.” It is home to 20 percent of the U.S. population but fewer than 10 percent of its doctors.
The deep divide: State borders create Medicaid haves and have-nots
Laura Ungar, Kaiser Health News, October 2
Patricia Powers went a few years without health insurance and couldn’t afford regular doctor visits. If Powers lived just across the Mississippi River in Illinois, she would have qualified for Medicaid, the federal-state health insurance program for low-income residents that 36 states and the District of Columbia decided to expand under the Affordable Care Act. State borders have become arbitrary dividing lines between Medicaid’s haves and have-nots, with Americans in similar financial straits facing vastly different health care fortunes. This affects everything from whether diseases are caught early to whether people can stay well enough to work.
For homeless Californians, the doctor is often the ER. Street medicine aims to change that
Matt Tinoco, KQED News, October 2
Instead of trying to power-wash the problem away, California’s hospitals, public health departments and homeless service organizations are increasingly sending trained health practitioners into homeless encampments in a quest to improve health outcomes for individual homeless people.
linking care and community
Hospitals are buying up housing units, helping ‘stranded’ patients find a home
Markian Hawryluk, USA Today, October 2
Legally and morally, hospitals cannot discharge patients if they have no safe place to go. So patients who are homeless, frail or live alone, or have unstable housing, can occupy hospital beds for weeks or months – long after their acute medical problem is resolved. For hospitals, it means losing money because a patient lingering in a bed without medical problems doesn’t generate much, if any, income. Meanwhile, acutely ill patients may wait days in the ER to be moved to a floor because a hospital’s beds are full. With recent federal policy changes that encourage hospitals to allocate charity dollars for housing, many hospitals realize it’s cheaper to provide a month of housing than to keep patients for a single night.
Can community investment improve health? Boston Children’s is spending $53 million to find out
Leah Samuel, The Boston Globe, September 27
Even back when most doctors made house calls, they weren’t expected to treat the entire neighborhood. Boston Children’s Hospital is in the midst of an effort to support community organizations that work on increasing access to housing and food and reducing economic inequality — basics that can shape health and determine a child’s future. Between 2018 and 2027, Boston Children’s will allocate $53.4 million in grants to Boston-area and statewide organizations that address racial, ethnic, and socioeconomic inequities in low-income communities.