Groups work to meet needs of the uninsured

State, nonprofit agencies create programs to offer affordable health care

Howard County

January 26, 2003|By Liz F. Kay | Liz F. Kay,SUN STAFF

Sondra Leonard of Jessup can't control her diabetes without the free samples of medication provided by the Health Alliance for Patients in Need, a free clinic in Columbia for chronically ill patients. She receives no health benefits at work, earning $10 an hour in a basic service job.

"If they don't have it, I can't afford it," she said of the medications. "It's just totally out of reach."

Health Alliance, staffed by volunteer physicians and nurses, is one link in an incomplete safety net for people in Howard County who can't afford care.

There is a national crisis in health care, experts agree, with more than 11 percent of Americans facing disease and illness without insurance. In Maryland, 9.9 percent of the population lacked medical insurance in 2000, according to a survey by the federal Centers for Disease Control and Prevention.

In contrast, less than 5 percent of Howard County's residents - fewer than 15,000 - lacked insurance, that survey showed. But Howard's health establishment is not satisfied.

At a time when health care costs are soaring and there is no promise of universal coverage, Howard health organizations are working to identify those denied basic care in this affluent community with the aim of providing them with affordable services. Often the only option for patients who don't qualify for Medicaid, the federal health insurance program for the poor, is the emergency room of Howard County General Hospital.

"The main question for Howard County is how do we build on the framework [of care available to the poor] that exists now and how to involve the medical community [in expanding access to care]," said Richard M. Krieg, president and chief executive officer of the Horizon Foundation, a nonprofit organization dedicated to county health care issues.

A safety net

The Health Alliance has long been a key source of care for county residents who do not have insurance. Concerned about uninsured patients with chronic diseases, a group of physicians and nurses started the foundation in 1994.

Since 1998, the volunteer physicians and nurses of the alliance have been providing free care in a clinic across the street from the hospital to uninsured adult patients with chronic conditions such as diabetes or heart disease. Last year, the clinic had more than 1,300 patient visits.

The Health Alliance hopes to expand the clinic's services in March to include routine care two Thursdays a month for poor children who lack government health insurance. It is unclear how many children would be eligible.

The Howard County Health Department also has been looking for ways to expand the medical safety net.

In April, it established a free dental clinic on U.S. 40 near Rogers Avenue in Ellicott City for children identified through a school screening program as needing dental care but lacking insurance. Adults referred to the dental clinic by Health Alliance are also treated.

Two dentists have been hired by the county to staff the clinic Mondays and Tuesdays. Volunteer specialists, including oral surgeons and orthodontists, supplement their work one half-day each Wednesday.

The county's oral health program, including education and oral cancer screening as well as the clinic, is funded by two state grants and one from the Horizon Foundation.

About 78 percent of students screened had untreated decay - 10 percent with disease so bad it required immediate treatment, according to Dr. Wendy Matt, director of the oral health program. Many factors, including a lack of insurance or fluoridated water, contributed to their condition, she said.

The program has served more than 130 patients in the past six months. Although the service has not been advertised, appointments are booked two to three months in advance.

Howard County also offers specific services that affect public health, such as screening for preventable cancers and sexually transmitted diseases. But the county can't offer comprehensive care, said Penny Borenstein, health officer for the state Department of Health and Mental Hygiene in Howard.

"We recognize that we're in much better shape than most communities in America," she said. But "it leaves me wanting for additional resources to provide care to even the relatively small population of uninsured."

"While our problems are always smaller, it doesn't make them any less a problem," agreed Pamela Mack, the Health Alliance's executive director.

"In the absence of a national health plan what we're left with is trying to expand on available services, pro bono services of health care providers," Borenstein said.

A health and human services study conducted by the county Department of Planning and Zoning last year shows that more than 14 percent of the county's residents depend on government health insurance - Medicare, Medicaid or Maryland Children's Health Insurance Program (M-CHIP).

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