September
2002
Leadership
Trenton: Urban health care delivery
By
Pamela Sims Jones
The
July 23rd Leadership Trenton session focused on health care delivery,
specifically Trenton's urban health care delivery system. Critical
areas explored were mental health; substance abuse; neo-natal,
pre-natal and primary care; domestic violence; parenting; and
chronic illness particularly cardiac, cancer and dialysis care.
The
morning session was an overview of what makes for a healthy community.
Presenters were Sonia Delgado, senior associate at the Princeton
Public Affairs Group; Judith Persichilli, CEO for St. Francis
Medical Center; and John Monahan, CEO of the Greater Trenton Mental
Health Center. Thinking like a health planner, and thinking from
a public health perspective, were the two approaches to the day.
Site visits included Capital Health System-Mercer Campus, St.
Francis Medical Center, Henry J. Austin Health Center, and the
Greater Trenton Mental Health Center.
There
are varied health-care services available in Trenton and the region;
however, there exists a gap in ensuring access and financing health
care for the uninsured and underserved. The Mercer County Human
Services Advisory Council presented a community issues briefing
in February. The council's members are concerned that the state
budget crisis will imposed a disproportionate share of funding
cutbacks on services targeted to low-income, high-risk community
residents.
Although
prevention is the key to all health care issues, external forces
such as political climate, economic conditions, physical environment,
social values and culture, and population characteristics affect
health care delivery and therefore make it impossible for the
uninsured to receive preventive treatment. For example, if an
individual or family is trying to find housing, reliable transportation,
and employment, health care needs become a low priority even though
it is a necessity, particularly for children.
Moreover,
the economics of health care are largely driven by social values.
In addition to environmental health issues such as air, noise
and housing, abuse, neglect and unemployment, the uninsured are
more likely to receive too little medical care and receive it
too late. Consequently, they will be sicker and die sooner, and
receive poorer care when they are in the hospital even for acute
situations like a car accident. The Institute of Medicine Committee
reported these findings on the consequences of uninsurance. According
to Ms. Persichilli, more than 100,000 people per year receive
episodic care in emergency rooms. There are roughly 30 million
working-age adults in the U.S. that are uninsured. And in New
Jersey there are more than one million uninsured residents.
One
area of resources for the uninsured is the thirteen federally
qualified health centers throughout the state. A fact sheet, published
by the New Jersey Primary Care Association (NJPCA), states the
following: "The 13 health centers in New Jersey provided
more than 725,000 primary care visits in 2000. The centers have
absorbed a large portion of the growing uninsured population…since
health centers are the only health care provides that are federally
legislated to provide services to all who enter their doors, even
those without ability to pay. Health centers in New Jersey are
truly the last of the safety net providers." The Henry J.
Austin Health Center in Trenton had a sliding fee scale of $25
to $215 that has been reduced to $10, and which may be reduced
to zero.
The
evening discussion brought about several conclusions: health care
is focused on illness rather than wellness; health is hard to
define because it is affected by many variables; and health care
delivery is political. A question was asked: "If you had
one thing you could do to improve health care, what would it be?"
One answer would be to reverse the above conclusions as follows:
make health care focused on wellness, make it easy to define,
and make health care available to every citizen regardless of
their socioeconomic background.
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Special
thanks to all of the agencies and their staff who contributed
to the success of our July seminar.
Pamela
Sims Jones is Acting Director of the Dept. of State's MLK, Jr.
Commemorative Commission.
