Updated: 3/18/2011 9:16 PM ET|
Uninsured? Where to get health care
Depending on your medical needs, you have several levels of health care available, from relatively inexpensive retail clinics to lifesaving, but expensive, emergency rooms.
Lack of insurance or timely access to your regular doctor doesn't have to mean going without needed health care.
If you're uninsured and seeking stopgap medical care before you find coverage again, you can triage your way to better health by understanding the trade-offs of several care options, experts say. A retail clinic, urgent care facility or community health center may be a suitable fit, depending on the severity of your medical need and your personal preferences.
A broad spectrum of care is available, from the limited offerings of a retail clinic to the high-end capacity of an emergency department, said Ateev Mehrotra, a policy analyst at Rand and a professor at the University of Pittsburgh School of Medicine.
"They're all places you don't need an appointment, there's open extended hours, and they're there to treat people who can't get in to see their regular provider," Mehrotra said.
If you have a regular doctor you'd like to keep seeing but fear you can't pay full price because of lost coverage, give the doctor a chance to work out a charity care arrangement, payment plan or possible treatment changes to lower costs, said Dr. Lori Heim, the president of the American Academy of Family Physicians, who practices in Laurinburg, N.C.
Most doctors will try to work with patients to ensure their continuity of care, she said. "Physicians also value that personal relationship that develops."
Still, a shortage of primary care physicians has left many scrambling to keep up with patient demand. The wait time for appointments can be a deal breaker, forcing patients to look elsewhere for care.
Convenience and expense are two reasons uninsured patients who suspect they have a routine minor ailment -- such as the flu, strep throat, simple bronchitis or a skin condition -- should consider visiting a retail clinic, Mehrotra said.
Retail clinics also typically offer vaccinations and physicals for school, camp or sports on a walk-in basis, and most are open evenings and weekends. They can be found in national chain stores such as Walgreens and CVS/pharmacy, as well as hospital systems. They're staffed by nurse practitioners or physician assistants who can diagnose and treat ailments and prescribe medication.
Unlike emergency rooms and other health care settings where there's no way to know how much the final bill will be, retail clinics post their prices on menu boards and often online.
Patients "know exactly what they're going to pay," Mehrotra said.
CVS/pharmacy stores, for example, have 500 MinuteClinics in 25 states. They're all open seven days a week and have weekday evening hours. The average cost of treatment is $62, said Andrew Sussman, the president of MinuteClinic, based in Minneapolis.
"It's Sunday morning and your 10-year-old has a sore throat and a fever," Sussman said. "We're a good option for people."
Retail clinics offer a quality of care equivalent to that of urgent care centers and private doctors' offices, according to a 2009 study from Rand. Its typical patients are young adults who have no regular health care provider.
Limitations: Patients looking for a doctor or on-site X-ray or lab facilities won't find them at retail clinics, and many of the clinics won't treat babies and toddlers younger than 18 months.
Urgent care centers
For care that's more comprehensive than that at retail clinics but not as complete as that offered in hospital emergency departments, urgent care centers are an option.
They also don't take appointments, but the centers do provide doctors and treatment for midlevel problems, such as simple fractures, sprains, bruises, burns and cuts requiring stitches. Many also treat asthma and bladder infections.
"Our goal is to get people in, treated and out within an hour," said Jim Greenwood, the CEO of Concentra, a Dallas health care provider that owns and operates more than 300 urgent care clinics in 40 states.
"We're not battling the primary care doctors," Greenwood said. "We're supplementing what they do."
Transparent pricing also has caught on at Concentra, which shows in English and Spanish the cost of three levels of service, which typically range from $95 to $190, he said.
Concentra's urgent care centers are generally located closer to where people work than where they live, and many have extended hours to accommodate patients' work schedules. Back pain is one of the top reasons patients seek care there, and each center is staffed with a doctor and a physical therapist, Greenwood said.
"The beauty of our model is the physician and the physical therapists are communicating," he said. "They know if the patient is getting better or not with physical therapy."
Limitations: Like retail clinics, urgent care centers typically don't treat infants. Costs are 30% to 40% higher than at retail clinics, reflecting more staff training and resources, Mehrotra said.
Community health centers
Community health centers are nonprofits that typically serve uninsured people and those with low incomes. They charge patients on a sliding fee scale, based on federal guidelines and a person's ability to pay.
"It's a good place to come and feel welcome without being embarrassed if you don't have the insurance or you don't have the money," said Lolita Lopez, the president of Westside Family Healthcare in Wilmington, Del.
Many health centers help patients with chronic conditions such as diabetes manage their ailments so they don't end up in costly emergency rooms.
Community health centers don't consider themselves one-shot deals. They offer an array of primary and preventive care services, sometimes including dental clinics, optometry, pediatric and obstetric/gynecology facilities under one roof. They often function as a medical home, a place patients can return to over time as theirs medical needs change.
"Their focus is on continuity of care, while retail clinics, urgent care and ERs are treating one problem and don't necessarily have to see you again," Mehrotra said.
Limitations: Most community health centers require appointments and documentation of income. Wait times can be long, because resources are often stretched thin -- even more so in this period of high joblessness. Nationally, health centers saw a 21% jump in uninsured patients between June 2008 and June 2009.
Hospital emergency rooms
Emergency rooms are always open and stocked with lifesaving equipment and personnel. Doctors say patients with potentially serious symptoms, such as a high fever, shortness of breath or chest pain, should seek ER care without delay. About half of emergency room patients are admitted to hospitals.
Limitations: Of all the above options, the ER is by far the most expensive place to receive medical care, and patients with less urgent needs can face long waits before being treated.
This article was reported by Kristen Gerencher for MarketWatch.
VIDEO ON MSN MONEY
A sore throat can be a sign of something more serious and could also lead to an undiagnosed diabetic complication. Meanwhile, Ex- Vice President Cheney, politicians, rich people have the very best of care and the rest of us make do. No, you do not need high tech care for every illness, but studies have shown that patients get better faster and with fewer complications when an RN is on duty in the hospital and so too when a fully- trained provider observes you, he/she is more in tune to all possibilities even without doing tests. In hospitals, a doctor oversees the PAs and NPs. Here it is a cheap way to provide health care to maximize profits.
The system keeps trying to convince us otherwise so they can keep their for profit money-makers that began in the 1980s with HMOs. This person who owns 400 urgent care clinics-obviously making a butt load of money at our expense and shareholders, accountants, holders of portfolios, financial advisers, all have their hand in our pocket and keep trying to convince us that a national health care program is socialism. The current system is pure unprecedented greed and people out of work or with huge medical bills cannot afford the money even for the one time visit. Ideally, there should be a follow-up to be sure the strep throat is cured or if asthma or a chronic condition, ongoing care is needed Tests incur additional costs. Physical therapy is not cheap and these urgent care sites require money up front. The whole system needs revamping and we need national health care, which is a right.
Capitalism is fine for selling iPODs, television sets, even gas, but some things are essential for life. Quality health care should not be compromised or sold to the highest bidder for the most profit.
ridicules prices for those unnecessary tests. Health care is out of price for the average person
The health system in this country is a joke. many Americans now have no health insurance. President Obama tried to address this problem but partisan politics and the insurance companies quickly derailed this plan. A government run health insurance program IS NOT an invasion of privacy as the politicos against Obama would like you to believe. These elected officials are in the pockets of health insurance companies who are in the business to make a profit. Those lucky enough to have insurance, these companies do not even want you to get sick because you cost them money.
I also am in the working poor bracket of Americans which has exploded in the past few years by the disappearance of the middle- class. Many companies that are hiring and offer health insurance hire part-time to avoid paying a percentage of health insurance premiums if hiring a full time employee. I also pay a high percentage of my income to doctor/prescription costs and live in a RV in a RV park and have little to nothing at the end of the month. The state of Florida repeatedly denies me medicaid/medicare because I am a single male with no children. I chose to work instead of being on the taxpayer roll but I need help in prescription costs which ENABLE me to work. It is a system broken. The millions such as us are denied a god-given right to adequate health care. Health care SHOULD NOT be a profit making business. It's immoral. If you make a car, TV, cell-phone, MP3 player etc (not required for life well being) then you are entitled to pursue a profit. Health care does not fit in this category. Do not be fooled by the health insurance companies who want you to believe that a government run health insurance option will not work or is bad for you in some way. We need to unite and demand this issue be returned to the table for approval. The US is the worst developed country in the world in health care for its citizens. Pitiful.
National health care advocate. You are 100 percent right. I didn't see your post when I wrote mine which parallels yours. Americans need to wake up and unite in demanding that this greed driven, inhumane health system of ours does not work.
I love how the article mentions emergency rooms. Yes, you can be seen by an emergency room if you are indigent. The problem is that they are only responsible to 'stabilize' your health problem. Unless you have a life threatening situation, the ER will quickly lead you out the door with a few prescriptions (that cannot be afforded) and a document stating the need for a follow-up appointment with a doctor or specialist that we couldn't afford to see that led us to the ER in the first place.
Southern home builder
not everyone can afford 167.00 a month. I'm on disability. I tried BlueCross but couldn't make the payments if I wanted to eat. So now I'm in medical debt over 1000.00. I have chronic life long conditions. Have no idea how to pay for what I need. Have prescription taht I can't afford. We aren't dumb and don't like being talked down to. So unless you've been where I am you should'nt act like we want to take advantage of the system. there is a big gap between the really poor and those that can afford insurance.
i have a condition because my doctor screwed up my surgery....unknown to me at the time or i wouldve sued him...now the statute of limitations has passed and i cant do a damn thing but suffer, every day...i was unemployed for 1.5 years and had to take the first job that came along, which doesnt offer insurance, because my unemployment benefits ran out. i had a whole month's notice....so its not about what kind of person i am its about the damn situation i have to deal with....i cant afford $160.00 a month and im a person with no bills except a small credit card bill that i keep for emergencies...i only have living expenses, i.e., mortgage, power bill, water, cable, (minimum) and a cell phone ($45 unlimited)...i am very frugal with my money, because i have to be...i only buy items that are on sale and this includes groceries...i dont smoke, drink or even go out...not even to a movie...if i cant find it on cable, i do without...i drive a 1997 car...im hot in the summer and cold in the winter, because i keep my thermostat low/high, accordingly...SO...to anyone who thinks that people are complaining because they have expensive taste and blow their money on things they dont really need....trust me, we dont.....and if you think that having bladder spasms and pain every time i go to the bathroom is something that will eventually go away...it isnt...i need surgery to correct the situation, not just medication..ive tried all the medications....ive done the tests....nothing works....im not old enuff, or pregnant or have breast cancer, so i dont qualify for medicaid/medicare....ive checked out most of these insurance quotes for AFFORDABLE inusurance....your $400, $300 or $200 policies, is not what i consider affordable...
I am not in favor of a national health system. I disagree with National Health Care Advocate that a national program is not socialist. A friend grew up on the shores of Lake Erie. According to her, many Canadians would take out a loan or a second mortgage to come across to the United States and get procedures or surgery that their doctors ordered or recommended, but "a committee" would not approve.
I do agree with National Healthy Care Advocate that greed is the problem. I also agree with Someone that much of the high costs are as a result of huge malpractice fees that physicians pay to insure that they are covered. Also the costs that pharmaceutical companies pay.
It's very frustrating to see problems with multiple causes but not see any solutions that do not infringe upon our freedom to seek and receive the care our practitioner recommends.
To reachhi: Go to your county Health Care District ,they can offer you very inexpensive medical coverage , I live in fl .lost my job and medical benefits, dont qualify for medicaid, but I went to my county HCD and I was approved, all I pay is $65.00 a month. I have a PCP and acces to specialists ,since I have diabetes. I hope this helps.
The Next To Last President
Barrack the next to last President
Had a contract put out on U.S.
His Government took power
The people lost theirs
There is only so much liberty
Either for him or for us
You will obey your master
He will make you pay and pay at the pump
Placing our resources off limits
Barry is smarter than all of US
He gloats as Illegal’s flood our country
Saying “That’s another vote for me!
Moslem terrorist stimulus plan
Watch out “Big and Little Satan”
The Free Market System is the only way
Of this I will never sway
“Never been proud of my country”
“Reparations don’t go far enough”
Can he bankrupt US into prosperity?
Wake up; it’s almost too late!
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