The Benefits of Preventive Care

An interesting, if somewhat mixed article about preventive health care in today's New York Times.  Some hospitals are attempting a new strategy that embraces free, preventive health care for people with chronic illnesses in an attempt to keep down longterm costs associated with repeated emergency room visits (emphasis mine):

With the number of
uninsured people in the United States reaching a record 46.6 million
last year, up by 7 million from 2000, Seton is one of a small number of
hospital systems around the country to have done the math and acted on
it. Officials decided that for many patients with chronic diseases, it
would be cheaper to provide free preventive care than to absorb the
high cost of repeated emergencies.

The idea seems like a sound strategy, and with high success rates among patients with ambulatory care sensitive conditions like asthma and diabetes, it seems like it could be a net positive for combating racial and ethnic disparities in health care (ACS conditions disproportionately affect low income communities and people of color). 

With reduced health care costs for tax payers and the hospitals, and greater adherence to the idea of healthcare as a human right, one would think that this is a win-win strategy for administrators and advocates alike.  The article goes on to note, however, that these trials are exceptions in the health care industry, not the rule.

In a heartbreaking anecdote, the story illustrates just how broken our health care system is, and how vulnerable many low income people and people of color are when it comes to receiving adequate - and vital - health care:

In March 2005, Ms. Martinez, a Seton patient, was found to have liver cancer. She was put on Medicaid, applied for federal disability and was put in line for a liver transplant,
without which, doctors said, she had six months to two years to live.
Through the summer of 2005, she made the hour-and-a-half drive from her
home to San Antonio for preparatory tests.

That August, she was
awarded disability payments of $561 a month. But because her income
surpassed the $535 limit for Medicaid in her circumstances, she said,
she was told by the state that her coverage had ended, and the hospital
said it could not proceed with a transplant.

“I asked Social
Security if they couldn’t just reduce my payments by $30 a month,” she
said, “but they said it doesn’t work that way.”

In another
twist, by federal rules, she will qualify for Medicare two years after
the initial finding of disability. She awaits the start of Medicare
coverage next March, when she can rejoin the transplant line.