November 23, 2015; Sacramento Bee
The Affordable Care Act (ACA) has allowed millions of people across the country to access health insurance and, in doing so, access healthcare. At least in theory. Healthcare delivery, it turns out, is an entirely different problem. But many nonprofit healthcare executives already knew this. As the ACA was being drafted, I often heard Barbara Mannino, the former CEO of Vista Community Clinic, say that ACA policy discussions were mostly about healthcare finance and not about healthcare delivery.
The actual delivery of healthcare services depends upon a number of factors. It depends in part upon the patient’s ability to seek care. For example, those who are low-income may have difficulty leaving work to attend a doctor’s appointment or paying for the gas to drive to that appointment. Healthcare delivery also depends upon whether the healthcare provider is sensitive to and supportive of the patient’s social and cultural background. And, of particular importance, healthcare delivery depends upon the availability of medical providers.
There is a documented shortage of primary care physicians in the United States, and the shortage is especially acute in rural and low-income areas. The physicians that do practice in rural areas are often operating at capacity and, thus, not accepting new patients. Some nonprofit health centers, such as the Shasta Community Health Center in Redding, have the patients and the facilities but struggle to recruit physicians to rural areas.
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Given these challenges, healthcare nonprofits are doing what nonprofit leaders have traditionally done well: They are getting creative. They are using mobile clinics and telemedicine (i.e., video conferencing) to reach as many patients as possible. Nonprofits are also, as the Health Resources and Services Administration suggests, using practitioners and physician’s assistants to alleviate the shortage of primary care physicians.
But, unfortunately, many of the nation’s newly insured are still either going without care or must go to great lengths to access care. Some of them are driving for hours just for a brief medical appointment.
Let us be clear: The ACA did not create these patients but, rather, provided the insurance through which medical care became financially feasible. As Dean Germano, CEO of Shasta CHC, told the Sacramento Bee, “The (Affordable Care Act) was kind of the shock factor that drove up the demand, but these individuals have always been in our community.”
Research has demonstrated that resource disparities—such as lack of access to primary care—exist in rural communities, low-income communities, and in communities of color. In California, there are also disparities between the northern and southern parts of the state, with a disproportionate percentage of nonprofit resources concentrated in urban areas such as Los Angeles and the Bay Area.—Jennifer Amanda Jones