Clinics and the Weight of the Wait

The Hourglass, Evelyn de Morgan (1850-1919)

In a post yesterday from Professor John V. Jacobi, he pointed out that “Uninsurance kills people, and extending coverage to all is critical.” A recent AP article, “Free Clinics Hit with More Patients, Less Funding ” is worth a quick read:

Like countless others stripped of health insurance because of the recession, Anderson and his family were forced to turn to a free health clinic. In all, about 4 million Americans are expected to visit the nation’s 1,200 free health clinics this year - a surge that comes as clinics face a drop-off in financial support.

“Over the last year, free clinics have seen patient load increase by 40 to 50 percent,” said Nicole D. Lamoureux, executive director of the National Association of Free Clinics. “People who just last year had health coverage are now out of work and need to have their health care needs met.”

And there is perhaps one aspect of the situation which the article does not address that is worth noting. With increase in volume and decrease in resources, wait times must mount. Wait time for the working poor can be onerous. Obviously, a long wait is a long wait for anyone, but if one is out of work the time element is not as pressing as it would be for one who is employed.

I had occasion recently to accompany someone to what will remain an unnamed sliding scale clinic in Elizabeth, N.J. She lacked transportation. The place was mobbed and although we had a 12 noon appointment, it took a full 3 and a half hours and then some to make it out of the waiting room,  and then another 45 minutes to an hour to be seen, examined and treated by a doctor. After paying the bill, I was lucky to get my companion to her  poorly paid no benefits job on time at 5pm. That job, difficult as it was to find in this economy, is pretty much all that stands between her and destitution. It is not a good job, but it is better than nothing. In speaking with the office manager/nurse, I was told that the wait time was, unfortunately, give or take “normal.” That funding was scarce and volume as high as it has ever been.

When it’s truly difficult to make ends meet, to find 4 or 5 hours to commit to a doctor  visit, as opposed to hustling the dollars one needs to squeak by, can be  hard. Arduous as the wait can be, it makes it that much easier to postpone the visit. And lest we forget for whom the bell tolls, if she postponed that visit to her ultimate detriment and wound up uninsured in an emergency room–the cost of care (falling, ultimately as it would, upon the public) would have been extreme by comparison: in health care, the old adage “a stitch in time saves nine” can sometimes seem modest. In addition, there is a national cost in lost productivity to consider. Earlier this year I wrote the following in regard to lost productivity through illness:

Having just returned from my family physician (who stayed open past hours to see me), perhaps you will forgive me if, not feeling well myself, I dwell for a moment upon the cost of illness and inefficiency. Not as a matter of out of pocket cost, per se, but as a matter of macroeconomic cost–a roughshod (I am sick) calculus based upon diminished productivity and national opportunity cost: simply put, if I am busy being sick, I may well have to forego the productivity of work–or I may perform that work at a lesser level ( I suppose this post will tell).

For the working poor, with very little buffer to sustain them, sickness can easily amount to a calculus of ruin.