POSTED ON JUNE 12, 2013:
Insurance only part of the struggle
Editor's Note: A month into our look at health care and 3.6 million Americans -- most living below the poverty line -- are looking down the barrel of being denied health care when Gov. Fallin takes it upon herself to opt out of the Affordable Care Act. So when UTW uses the term "Medicaid crisis," we do not do so lightly. Jaime Adame continues his look at the crisis, examining programs that look to bridge the gaps, looking at things like the end of Insure Oklahoma, and generally investigating just what the hell regular folks without insurance are supposed to do. Stay tuned. There's a lot more coming.
By Jaime Adame
t's been about nine months since the Tulsa City-County Health Department opened up its gleaming new health clinic in North Tulsa.
So far, the patient load is "appropriate," said Reggie Ivey, the department's chief operating officer.
"We can certainly see more clients, but we know that will come with time," Ivey said. He described how the department opened the approximately $8.2 million center knowing it would "take about a year for our clinic to be established in the community."
Throughout Tulsa, demand for health services remains strong in underserved areas. But some note that it may not be the top priority for residents, despite their abundant health needs.
At E. 61st Street and S. Peoria Avenue, the city established a quality-of-life task force to look at problems in the neighborhood. The group formed shortly after the shooting deaths of four women in January.
Kayla Johnson, principal of Marshall Elementary School, chairs the portion of the group studying health needs in the neighborhood.
In part through data collected by the health department, Johnson described an overview of the area's health-related needs.
"I think clearly through our conversations and through the data, residents really would love... some more opportunities for activities and health and fitness type opportunities and kind of, from the health perspective, support that might address the drug and alcohol" community problems, Johnson said.
Boosting the number of health care providers in the community "did come up as a priority, but it wasn't the top priority," Johnson said.
So, for now, anyway, the quality-of-life task force has focused on finding a way to build a community center that might be a meeting spot for healthy activities, Johnson said.
"At least half of the people that participated in the survey or the focus groups believe that they have good or excellent health care," Johnson said, acknowledging that the figure "may not sound like a lot." But she emphasized its meaning when trying to prioritize community needs.
"It's on their minds, but it may not be the crisis that we thought it was when we first started this committee work," Johnson said.
She acknowledged that she didn't know the specifics of the "good or excellent health care" identified by many in the survey.
"We do know that many use the ER, so what the survey data doesn't tell us is, really, what that access is," Johnson said. "It says they think the quality is ok, even through access is an issue. But you have to wonder if they're just talking about their access to the emergency room and not to a primary care physician."
Johnson also mentioned the mobile health care clinic provided by Good Samaritan Health Services.
Talking to George Valverde, administrator for the organization, reveals a difference in describing the urgency of community health needs, however.
The nonprofit sets up regularly for a half-day clinic in a church parking lot, Valverde said, noting that the organization sets up similar mobile medical clinics in a total of 14 locations in the Tulsa area.
"It is always a free clinic," Valverde said.
When the clinic was first set up at Riverside Baptist Church about five year ago, patients simply lined up before the 9am opening time for the clinic.
"People started lining up outside as early as five in the morning," Valverde said, calling it a safety concern. Now, the clinic uses an appointment scheduling system.
"I would say that is a pocket of great need," Valverde said.
Dr. Laura Dempsey-Polan, chief of community and systems development at Morton Comprehensive Health Services, said each of the system's six sites in northeast Oklahoma "is seeing quite a few patients."
However, she singled out Morton's site just north of downtown and its eastside clinic as its busiest.
Morton works to make sure residents know about the clinic services, and also to make it easy for them to get to their appointments.
"We're the only system in the state that provides free transportation to and from appointments," Dempsey-Polan said, describing how a large percentage of people in Tulsa don't own a car. "They may wait until the last minute to go to the emergency room."
She described how it's still important to increase awareness about the clinics' services to get people to think about coming in for care.
"A lot of folks out in the community don't even bother to think about this, because they just assume they will be rejected," Dempsey-Polan said.
By the numbers, more than 50 percent of patients treated at Morton clinics have no insurance, she said, while roughly 40 percent rely on Medicaid.
She said Morton backs Medicaid expansion, though state leaders have thus far declined to take part in this part of the Affordable Care Act.
"It only makes good sense. When you can get someone coverage, you can get them the care that they need early," Dempsey-Polan said.
As far as the nature of what people want out of health care, Ivey talked about how the northside clinic has had success with cooking classes.
"Really, we're interested in preventative care, and so a lot of our services are preventive-natured ... what we're trying to promote is preventative, so residents don't experience chronic illness prematurely," Ivey said.
Health department data from its survey found that, for north Tulsa County, only 15 percent had no health insurance, though Ivey said many of the people who visit the clinic rely on Medicaid.
Regardless, "having insurance doesn't mean that a person is utilizing it," noted Ivey.
So, a healthy cooking class -- for men only -- serves a dual purpose.
"The class is full," Ivey said, with 20 signed up.
But along with perhaps improving health through better nutrition, such a class also gets a segment of the population thinking more about the medical services offered at the site.
"When we looked at heath statistics in 2006, particularly African-American men were slow to get into care," Ivey said, noting that outcomes for problems like prostate cancer were troubling.
The cooking class is "kind of an unusual way to get the men familiar with the center," Ivey acknowledged, but he described the effort as part of "an earnest attempt to attract more men" to visit the clinic.
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