November 13, 2003
Project Access could boost
health and business climate
by: Addy Hatch
The ranks of workers who lack health insurance are swelling, and they work for all sizes of companies. In fact, a recent national study found that a third of uninsured workers today are employed by big companies.
How does that impact you, Mr. or Ms. Businessperson? By now, you should know. Uninsured people tend to put off health care until they're very sick, then use expensive hospital emergency-room services for their treatment. That drives up the cost of health care for everyone.
Equally important, however, is that uninsured workers usually aren't as healthy as their insured counterparts, and sick workers impact your business's productivity and its profitability.
That's where Project Access comes in.
The health-improvement effort launched here in September offers free health care-no strings attached-to low-income, uninsured people in Spokane County who don't qualify for government-funded health-insurance programs. About 100 recipients are in the program thus far, with a target of more than 2,000 eventually.
Under Project Access, doctors, hospitals, physical therapists, and others agree to provide health care to enrollees at no charge. So far, more than 500 of the county's 950 doctors have agreed to participate, and all six of the county's major hospitals are on board. The Physician Hospital Community Organization is donating data-processing services that alone are valued at more than $100,000 a year.
What's in it for these participants? Most doctors and hospitals already provide a significant amount of care for which they aren't paid, and Project Access helps coordinate that care, says Dr. Samuel Selinger, a semi-retired heart surgeon who is spearheading the effort here. Through that coordination, doctors are assured that patients are able to fill the prescriptions they write and receive the surgery, X-rays, or specialty-care consults they recommend. Without that assurance, the original doctor's time likely was wasted, Selinger contends.
He tells the story of a 35-year-old woman who visited a community health clinic, where Selinger works, to have a persistent cough checked. Unfortunately, the woman didn't have enough money to buy the medicine prescribed by the primary-care doctor at the clinic, and she got sicker. She ended up receiving emergency care for the condition, which she can't pay for, and lost her job because of the time she had to be away from work. Under Project Access, she could have filled her prescription for a $4 co-pay, and likely would have remained a healthy, employed, tax-paying member of the community. Which is the better scenario?
Keeping people healthy is a worthy goal, but it's more than just an exercise in altruism.
In Selinger's view, "It's the health of your work force and your employees-the things that make your economy grow."
In Buncombe County, North Carolina-the community that conceived of Project Access and launched it seven years ago-the percentage of people who say they have good or excellent health is the same for both insured and uninsured residents. Studies done there also show that productivity in the county is up 25 percent, and absenteeism is down 13 percent. The monthly per capita cost of providing charity medical care there has fallen by 45 percent.
Compared with a community that hasn't experienced those improvements, all other things being equal, where would you rather be an employer?
Even if you provide health insurance to your employees, you might not insure them all, because some work part time or haven't worked for you long enough to qualify for coverage. It would be nice to know that those people are able to receive regular health care, too.
The only thing Project Access asks from the community in general is that it bankrolls the prescription medications provided to enrollees. Project Access here was awarded a Robert Wood Johnson Foundation grant to cover its administrative expenses for the first three years (in itself a big coup), but it's hard to obtain grants for ongoing expenses like medications, Selinger says. Project Access plans to get the medicines through bulk purchasers, such as Group Health Cooperative, to get the best price possible, and it follows a pretty strict formulary so that people can't have expensive brand-name medications, rather than generic drugs, just because they want them. Still, it will need to raise a good deal of money each year to cover those costs-about $495,000 annually when the program is fully under way, according to the Spokane County Medical Society, which oversees Project Access here.
Some government entities here have agreed to earmark funds for prescriptions under Project Access, and that's a good start. So far, however, Project Access doesn't have as much prescription funding as it believes it will need.
Here's what I like about Project Access: It doesn't duplicate efforts, because anyone who's eligible for other health coverage is referred to those programs. People are enrolled for a finite period-90 days-although they can re-enroll if their doctor believes they still need treatment and they continue to meet eligibility criteria. Also, enrollees have some responsibility-if they miss two medical appointments, they're kicked out of the program.
What I like mostly, though, is that it's a service for working people that's been proven to work. And when it does work, we all benefit.