Poor people in the U.S. dying because they can't afford medical care

www.usatoday.com/news/health/story/2012-04-20/community-health-centers-care-levels-differ/54363220/1

By Phil Galewitz, Kaiser Health News 4/18/2012

STONE MOUNTAIN, Ga. – At Oakhurst Medical Center here, just 20% of children have received all their recommended immunizations by age 2

Adults don't fare much better at this community health center, which provides primary care to 14,000 mostly poor people in a town famous for its granite monolith and "Confederate Mount Rushmore," just east of Atlanta.

Fewer than half of its diabetics and a little more than a third of those with high blood pressure had their conditions under control in 2010 — far below national averages for the U.S. population, according to a Kaiser Health News-USA TODAY analysis of the latest federal data.

But 65 miles east of here in Greensboro in rural central Georgia, it's a different story. At TenderCare Clinic, almost all children get the appropriate immunizations, and eight out 10 diabetics have normal blood sugar levels.

The marked differences between Oakhurst and TenderCare underscore the wide variability in how well community health centers are caring for millions of people nationwide.

"There is tremendous performance variation within community health centers and also tremendous variation among any health providers, hospitals, nursing homes, doctors," says Deborah Gurewich, a Brandeis University researcher. "That's the American health system."

Lower-performing centers typically have a higher proportion of uninsured patients and more staff turnover, she says. Most also lack electronic record systems, which makes it harder to track patients.

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Still, says Dave Ringer, a family doctor, it's not unusual for patients to tell him they cannot keep appointments because they couldn't pay a family member for a ride.

The center also has trouble finding specialists and hospitals willing to provide surgery to its uninsured patients. While many health centers have trouble finding specialists and hospitals to do surgery on patients without insurance, TenderCare is in a more precarious spot because it is outside the areas covered by Grady Memorial, the large public hospital in Atlanta, and Medical College of Georgia in Athens.

In the past year, an uninsured man waited more than eight months to find a neurosurgeon to operate on a brain tumor, Ringer says. An uninsured woman died of cervical cancer after waiting a year to find a surgeon.

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