Poor `falling through cracks' in medical system, study says

Access, debt when treated among problems found

July 31, 2002|By M. William Salganik | M. William Salganik,SUN STAFF

The poor in Maryland are having trouble getting to medical care - and are running into debt and being hounded by collection agencies when they do get treated, according to a study released yesterday by the Open Society Institute-Baltimore.

"These people are clearly falling though the cracks in the system," said Dr. Thomas P. O'Toole, an assistant professor of medicine at the Johns Hopkins School of Medicine and program officer for the Open Society Institute.

O'Toole coordinated the study, in which medical students, working for the summer at the institute, interviewed 274 patients at health clinics and resource centers in the city. Some were found to be getting some care, but more than half reported problems getting care.

Forty-six percent of those interviewed said they owed money for treatment they had gotten. The average reported medical debt was $3,409, nearly half the average $7,864 annual income of those surveyed. Of those with debt, four in five reported having been contacted by a collection agency.

Those with medical debts, the study found, tended to delay seeing medical providers, change providers to avoid going to one where they owed money or got care only from a hospital emergency department. That meant, O'Toole said, that those patients "lose the whole effect of having continuity of care" for chronic conditions.

O'Toole said the study did not show how many people in the state were having problems getting medical care for financial reasons.

The federal Census Bureau estimates that 9.8 percent of Marylanders, about 500,000 people, are uninsured. About half of the people interviewed in the institute study were insured but had problems with deductibles, co-payments and treatments not covered by their insurance.

The survey found that even those getting treatment at free clinics were having billing and other problems.

Dr. Njide Udochi, medical director of Health Care for the Homeless, which runs one of the clinics in Baltimore where the survey was conducted, said patients can receive basic care at her clinic but often incur debts for services the "safety net" clinics generally don't provide, such as seeing specialists, getting inpatient care, visiting emergency rooms or getting laboratory tests.

Kiana Hebron, a University of Maryland medical student who was one of the interviewers, described a 43-year-old HIV-positive woman receiving basic care at Chase Brexton Health Center downtown who had "a great deal of medical debt from previous hospitalizations."

Expanding insurance coverage is expected to be an issue in next year's state legislative session. House Speaker Casper R. Taylor Jr. announced last month that he is working on several proposals for covering more of the uninsured.

Vincent DeMarco, executive director of Maryland Citizens Health Initiative, a group seeking universal health insurance for Maryland, said during the institute's news conference that more than 140 candidates for legislative seats had endorsed three key proposals from his group, including an increase in the tobacco tax to finance health coverage for more people.

The other proposals endorsed by candidates are a buying group to make prescriptions more affordable for the elderly and maintaining CareFirst BlueCross BlueShield as a nonprofit insurer.

Open Society Institute, a foundation founded by financier and philanthropist George Soros, distributes about $7 million a year in grants for dealing with urban problems in Baltimore.

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