Thursday, April 2, 2009
Safety Nets with Holes
MetroHealth System in Cleveland, Ohio is supposedly the safety net hospital of northeast Ohio. Or at least it was, before last summer's move to restrict the provision of free care to only those patients who have an address within the confines of Cuyahoga County. This excludes all the people in Lake and Geauga counties (population close to 400,000) without health insurance.
As a result we are starting to see more of the following:
1) 50 year old gentlemen with rectal cancer laid off from his factory job, without any insurance. He underwent neoadjuvant chemoradiation and then I did an abdominoperineal resection. HCAP (hospital care assurance program) will help him with his in-hospital costs but the medical oncologist, the radiation oncologist, and myself are not likely to be compensated. The burden of providing free care, because of the decision of Metrohealth, falls not on "society" but instead on individuals in the community who feel obligated to "do the right thing".
2)47 yo woman with melanoma who needs a wide excision and sentinel lymph node biopsy. She has no insurance. She lives alone, is unmarried, and has no family in the area. She showed up in my office for the initial consultation with some crumpled up dollar bills. It's heartbreaking. I tell her to put her money away and worry about getting well.
I don't know what the answers are. But I do know that safety net intitutions can be a valuable resource. Diminishing how wide that net gets cast for the sake of improving the county budget bottom line is borderline irresponsible. Someone has to take care of these people....