The headline of this Times-Picayune article about health care in post-Katrina New Orleans misses much larger points about the health care system, the providers and the patients in this city:
"Without Charity Hospital, the poor and uninsured struggle to find health care"
Um...the poor and uninsured in New Orleans struggled to find health care even with Charity Hospital.
At one point in the 20th century, Charity could boast about being a pre-eminent American Hospital. But years of budget cuts, lack of upkeep and the city's overall financial decline decimated its quality well before Katrina. Moreover, the pre-eminence of a single hospital as the sole provider of health care came into question even while Charity operated at its peak. An ACP article summed up this dilemma in 1999 (6 years before Katrina):
"Charity Hospital is such a critical component of New Orleans' health care because it serves one of the nation's largest metropolitan concentrations of the poor and uninsured. Louisiana ranks fifth in the country in the percentage of its population without health insurance; its poverty rate is the fourth worst in the nation. In New Orleans, 22% of the residents have no insurance and just over half of the city's adults get health insurance through their work. (Many of the city's jobs are in the relatively low-paying tourism and service industries.)
Add the fact that there is no effective system for delivering primary care throughout the neighborhoods, and it is not surprising that the "underlying health status indicators here are terrible," said Kenneth Thorpe, PhD, of Tulane University's Institute for Health Services Research. A 1998 report published by the state identified Louisiana as 48th in the country based on various health indicators, including higher-than-expected rates of cancer, diabetes and infant mortality." (Emphasis mine.)
The public health officials in this city never worked out a way to provide primary care while Charity Hospital existed. As a consequence, most patients ended up in Charity's waiting rooms, "bringing a breakfast and lunch", for end-stage disease treatment rather than preventive or early-stage treatment. So while the headline of the Times-Picayune article tugs for tears, the body of the article actually contains hope:
"This is the health care safety net in post-Katrina New Orleans: patchy and provisional, propped up by miracle and chance, and heavily reliant on the charity of high-minded doctors, nurses and social workers who scrap for ailing patients, often by calling in favors with physicians or private hospitals. As with so many aspects of storm recovery, the hard work of ordinary citizens has substituted for an institutional solution."
While the public health officials dawdled after Katrina, in their vacuum a disparate group of health care workers built the community clinics sorely needed (even before the storm). While the early days of these clinics could be rightly described as "charity", these clinics - Common Ground, St. Thomas, the Tulane University Community Health Center at the Covenant House, St. Cecylia, the Woman's Clinic, et. al - have matured into more sustainable, professional clinics. They have sought various funding sources, joined alliances and networks, began charging and taking insurance and have become an important cog in the health care system.
So now, poor and uninsured patients can reasonably expect to be seen in a community clinic instead of waiting in the Charity Hospital ER. In some senses, this marks a huge leap forward in primary care in New Orleans. And while I see massive holes in specialty and tertiary care (patients have to travel an hour for chemotherapy, ENT, ophthalmology, orthopedics...), let's not sugar-coat the pre-Katrina Charity system.
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