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COUNTY DOCTORS EXPAND CARE ACCESS Series: CARING FOR THE UNINSURED An Occasional Series

Posted on: Tuesday, 4 October 2005, 03:01 CDT

By PHIL GALEWITZ Palm Beach Post Staff Writer

About 350 Palm Beach County doctors will begin offering free health care to uninsured county residents this week under an ambitious program to give those without health coverage easier access to medical specialists, hospital services and prescription drugs.

The initiative, called Project Access and organized by the Palm Beach County Medical Society, aims to better coordinate care to the uninsured, increase the number of physicians who treat them and quantify the extent of the uninsured residents in one of the richest counties in Florida.

About 250,000 county residents, or about 19 percent of the population, are uninsured, according to the latest state study.

Residents who make less than $19,140 as an individual or $38,700 for a family of four will be eligible for Project Access. Participants will get free care in doctors' offices or at local health clinics for up to three months, though they will be able to reapply in certain cases.

The program is not meant to replace insurance but rather help the uninsured deal with immediate health needs.

Lack of health insurance is considered one of the top public health issues because the uninsured typically delay seeking medical care because of the cost, studies show. As a result, they are more likely to suffer from chronic diseases such as diabetes and more likely to die earlier from treatable conditions.

"It's an amazing feat to get 350 doctors to agree to do anything," said Dr. Ivy Faske, a Palm Beach Gardens pediatrician and president of the county medical society. "This shows the level of feeling that our local doctors have to those in need."

About a third of the doctors are primary-care physicians, and the rest include most types of specialists, including cardiologists, oncologists, dermatologists and orthopedic surgeons. Most have agreed to see at least one or two patients a month as part of the Project Access program.

Several local hospitals are expected to participate, including Glades General Hospital in Belle Glade, JFK Medical Center in Atlantis and Bethesda Memorial Hospital in Boynton Beach.

A two-person staff at the medical society runs the new program, including signing up patients and making appointments with participating physicians, hospitals and other health centers. The program is operating on a $450,000 budget, with most of the money coming from the West Palm Beach-based Quantum Foundation. The money helps pay for a computer system and prescription drugs.

Modeled after N.C. program

The program is modeled after a Project Access program first started by doctors in Asheville, N.C., in 1997 and now operates in nearly 100 communities across the country. The success of the programs has varied, depending mainly on the level of physician involvement.

One reason so many of Palm Beach County's 2,000 doctors signed up to treat the uninsured is because they were convinced it wouldn't increase their medical malpractice risk. The state legislature this year, on the urging of the county medical society, passed a law giving doctors immunity from malpractice lawsuits when they provide free care to patients with incomes up to twice the federal poverty level ($19,140 for an individual).

When the uninsured seek care, they often go to hospital emergency rooms, which have the highest costs and where patients often wait many hours for care. There are several free clinics Palm Beach County, such as Samaritan Gardens in downtown West Palm Beach and the Caridad Health Clinic west of Boynton Beach.

While the uninsured can usually find primary-care physicians, they can have a difficult time finding specialists, getting lab tests and paying for prescription drugs. That's where Project Access steps in. The program will act as a referral source for the free clinics and doctors trying to find specialists and other health services for patients. It also will help them sign up patients for free prescription drugs offered by pharmaceutical companies or directly supply them some medications.

"This is a great thing for the community," said Pedro del Sol, CEO of Caridad Health Clinic. The clinic often struggles to find specialists to treat its patients with cancer and other serious conditions.

The program will rotate referrals to doctors to better distribute the burden. Patients will also be assigned to doctors based on where they live.

Dr. Lee Fischer, a Lake Worth family doctor participating in Project Access, said the program will help get services to uninsured patients that he can't offer in his office, such as lab tests.

"This will help streamline that care so we don't have to beg to find the service," he said.

Attracting attention

Doctors in Palm Beach County, like those around the country, say they already provide free or discounted care to patients without insurance, though most physicians don't advertise the service. Project Access organizers say the program will show the community the extent and amount of health services doctors give away, which they hope will attract the attention of government leaders to develop a national solution to the uninsured crisis.

Project Access will complement the Coordinated Care Program run by the Health Care District of Palm Beach County. This coverage program is available for uninsured county residents with incomes below 150 percent of the federal poverty level, or $14,355 for an individual or $29,025 for a family of four. To be eligible for Coordinated Care, residents can't have more than $5,000 in assets, not including their primary home and car. Project Access has no asset requirements.

phil_galewitz@pbpost.com

Project Access

What it does: Gives county residents short-term access to free health care from more than 350 county doctors and several hospitals and other health centers, including labs and diagnostic imaging centers.

Who qualifies: County residents who are uninsured and have income level below $19,140 for an individual or $38,700 for a family of four.

Why it's needed: The county has 250,000 people without health insurance. Many patients otherwise can't afford to see specialists or buy prescription drugs.

For more information: People can call (561) 433-3940.

Uninsured by family income

The large majority of uninsured Palm Beach County residents lives in households making less than $25,000 a year.

Percentage of uninsured by annual family income

Less than $5,000 43.4%

$5,000-$9,900 45.9%

$10,000-$14,999 45.9%

$15,000-$19,999 53.4%

$20,000-$24,999 44.0%

$25,000-$34,999 32.5%

$35,000-$44,999 18.0%

$45,000-$54,999 15.1%

$55,000-$64,999 13.5%

$65,000-$74,999 9.7%

$75,000-$84,000 6.5%

$85,000-$94,999 3.7%

$95,000 or more 4.7%

Source: Florida Health Insurance Study

Uninsured by employment status

Nearly 250,000 Palm Beach County residents, or 19 percent, don't have health insurance. While most of the uninsured are poor, many middle-class residents also lack coverage. A majority of the county's uninsured are working, though typically in either part- time or self-employed jobs that don't provide health coverage.

Uninsured residents by employment status

Employed full time 13.2%

Employed part time 27.9%

Exclusively self-employed 24.4%

Unemployed* 45.1%

Not in the workforce* 18.6%

*Unemployed people are actively looking for a job, while those not in the workforce include retirees, students, parents at home and others who are not presently looking for employment. Full-time employment is three or more hours a week.

Source: Florida Health Insurance Study

Source: Palm Beach Post

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