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Thursday, June 25, 2009
Crowded emergency rooms, rising health insurance premiums and budget-breaking prescription drugs have fueled a health care crisis that affects nearly everyone. Recently, President Barack Obama and Congress have introduced plans for fixing this broken system. Even if Washington overcomes the entrenched interests that have blocked reform for decades, however, national changes will not happen for years, and Austin cannot wait that long to improve care for its uninsured.
Some important changes are underway. Earlier this year, Austin's safety net of city clinics evolved into a nonprofit corporation known as CommUnityCare. These health care centers have served our community since 1970, providing a range of services, including primary care, dental care, women's and children's services, and mental health for residents who qualify.
With the transition, services have been expanded to meet the ever-increasing need. Because of the demand for same-day appointments and urgent care, a health center at Rundberg and Interstate 35 was created, and walk-in health centers were added to two sites (Red River and William Cannon). The Travis County Healthcare District is also building a large facililty to replace Northeast Clinic, where the wait for appointments reached several months. In another innovative solution, the district contracted with local urgent care centers to provide same-day sick care appointments.
Despite these crucial steps, Travis County's health care needs are still unfulfilled. With nearly one in five Central Texans lacking health insurance, primary care capacity remains woefully inadequate, forcing many to seek care in busy emergency rooms for minor needs, or to forgo care until the need becomes critical.
Our health care district faces several great challenges. Foremost is the chronic problem of underfunding, which has worsened with the recent economic downturn. Tax revenues have been jeopardized by the weakening housing market, but more importantly, many people have been forced out of the middle class and into the bulging safety net. For non-established patients, the wait just to be screened for eligibility can be weeks or even months. To see a doctor takes even longer. CommUnityCare and other primary care facilities for the uninsured are simply unable to accommodate everyone who qualifies.
Furthermore, many specialty clinics at Brackenridge are understaffed, forcing patients to wait nearly a year, in some cases, to see certain specialists. Perhaps most troubling, mental health services continue to be inadequate. In a survey conducted by Austin Physicians for Social Responsibility in 2006, 75 percent of primary care physicians felt that accessing mental health services is "extremely difficult compared to other specialties." Over 95 percent reported having seen some negative outcomes in patients unable to access care, such as inappropriate ER visits or suicide attempts. The health care district has wisely budgeted about $5 million this fiscal year for inpatient care for those with mental health crises. However, the problem of access to mental health care remains daunting and complex, for both the privately insured and the publicly funded, and few can argue that the system works well.
How can we best advocate for our community's health? First, we can urge our city, county and health care district leadership to ensure that all residents have access to a medical home — a primary care health center that provides well-child checks, prenatal care, and routine visits for acute and chronic health issues. In an ideal medical home, patients see the same doctor or nurse practitioner over many years, and they can access preventive services, like cancer screenings and cholesterol testing. The medical home approach to health care is far more cost-effective and efficient than the desperate searches for care after routine health needs turn into serious health crises.
We should also insist that specialty care clinics, dental services and mental health services are adequately funded and accessible. In particular, the consequences of untreated mental illness, including homelessness, unemployment and increased criminal activity, cannot be understated.
The transition to CommUnityCare, the expansion of services, and new partnerships engineered by the Healthcare District are steps in the right direction. But without adequate funding and direction, Austin will never be able to ensure appropriate access to care. As health care professionals, we are optimistic that national changes will aid Austin residents, with or without insurance. We shouldn't wait, however, for national reforms before we expand healthcare access in our community.
Williams and O'Day, a nurse, are board members of
Austin Physicians for Social Responsibility.