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San Diego County Community Clinics Juggle Funding

Posted on: Tuesday, 28 December 2004, 21:00 CST

Dec. 27--From the moment a patient walks into one of North County's 14 community clinics, everyone from the receptionist to the doctor begins sizing him or her up. Is the person male or female? White, black, Latino or American Indian? Does he have diabetes, dental problems, an infectious disease? Is she pregnant? A senior citizen? A low-income woman with a child?

They're not checking patients for health problems -- not exclusively, anyway.

Instead, these health-care workers are running through the list of dozens of categories of health-care funding the clinic receives, trying to figure out how best to pay for each patient's care.

If a patient has dental problems, they're in luck. Local clinics have just received grants to hire more dentists.

But if he has tuberculosis, the clinic may not be able to help. At least one local clinic just lost its funding for TB prevention. Another clinic still has money to test for TB, but if a patient turns up positive for the contagious disease, the clinic will have to send him elsewhere because government money for TB treatment hasn't been renewed this year.

Local community clinics say the juggle for funding is part of life in most of California, which relies on a convoluted system of state and federal grants to pay for public clinic care. It's a system that lays out dozens of priorities each year -- nearly all decided by politicians, not doctors -- and then asks clinics to figure out whether each of their thousands of patients fits into those priorities.

"We at community clinics live on a fragmented system of paying for care," said Barbara Mannino, executive director of the Vista Community Clinic, which has five sites in Oceanside and Vista.

About half of the clinic's income comes from medical bills and insurance. The other half comes from philanthropy, government contracts and grants.

Those contracts and grants "change every year based on political will," Mannino said.

This year, the clinic will lose funding for some of its migrant and farm-worker health-care programs, car-seat education programs for parents, cultural awareness programs for health-care workers, and a tuberculosis prevention program that identifies and tests high-risk patients before they can spread TB.

In turn, it will gain more money for dental care and childhood obesity prevention, which have become areas of growing political concern to the public and its legislators.

"There are some things that have been ignored for so long that have come to the forefront this year in sometimes shocking ways," Mannino said, noting that childhood obesity has become a high-profile problem this year.

"One-third of the kids under the age of 2 who we see at the clinic are overweight, and one-fourth are obese," Mannino said. "When people hear statistics like that over and over again and they are driven home in the media, then people pay attention and all of a sudden there is money for childhood obesity prevention this year."

Likewise, when the political tide leans toward non-health-related issues, community clinics brace for cuts, especially in federal programs.

"This year we are not expecting much help from the federal government," said Irma Cota, chief executive officer of North County Health Services. "On that level, there is war and there are tax cuts on the brain. That doesn't leave much room for us."

North County Health Services, which runs nine North County community clinics, said it will also receive more money this year for dental services, and will spend it on a traveling dental-care center that visits schools and remote areas.

"We're thrilled about that, because there is a lot of pent-up need with dental care," Cota said. "A lot of parents only take their kids (to the dentist) when they are in pain, and that can be too late."

Like the Vista Community Clinic, North County Health Services will lose some money for fighting tuberculosis. The clinic will continue to test for TB, a highly contagious respiratory disease that, according to the state's health services department, predominantly infects California's migrant populations.

The clinic will continue to have money to test for TB, but will have to send patients to local hospitals and other doctors for treatment, Cota said.

Cota said she worries some patients will leave the clinic with the disease and fail to seek treatment elsewhere or will spread the disease in the time it takes to travel between the clinic and the hospital.

"The concern would be that the individuals may not go in for care on time or at all," Cota said. "It used to be they trusted us and we could treat them. Now we have to send them somewhere else."

The gaps in funding at North County's clinics are typical of most clinics in San Diego and Imperial counties, said Alaina Dall, director of policy and community health for the Council of Community Clinics in San Diego.

Throughout San Diego County, Dall said, many clinics have money to screen for diseases like cancer but don't have the money to treat such diseases.

"It's extremely complicated, almost criminal from a health standpoint," Dall said. "There are multiple ... sources of money, all with different criteria."

Dall said it is unlikely that the complex structure of community clinic funding will change anytime soon, but that groups like the Council of Community Clinics are fighting to protect the state and federal money set aside for community clinics.

"Our main concern is to preserve access to care for our community clinic patients," she said. "We are all for streamlining and simplifying the funding, but we are interested first in preserving it."

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(c) 2004, North County Times, Escondido, Calif. Distributed by Knight Ridder/Tribune Business News. For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: North County Times

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