What can charity care accomplish?

    Lawmakers say a network of volunteer doctors is lifting the burden of the uninsured in Lancaster County.

    Pennsylvania’s health reform debate includes a Republican plan to create a network of volunteer doctors. The state has more than one million uninsured residents, and supporters say the charity care network could provide health care for nearly 160,000 people. Skeptics says volunteerism is a poor substitute for universal health-care coverage. WHYY reports on the program that inspired the legislation. (Photo: Flickr/nicdalic)



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    Family physician Christopher Hager says he and lots of his colleagues provide free medical care for uninsured patients. But Hager says free time with a doctor can lead to some major costs.

    Hager: If I get this chest x-ray, it’s going to cost $200. How are they going to afford this? Can they afford the antibiotics? And that is the challenge, is trying to make sure that I’m doing what I need to as a physician but trying to make sure that I don’t totally financially devastate them.

    Hager is president of the foundation that runs Project Access Lancaster County — or PALCO. He remembers when a patient came in needing help for a painful, swollen knee.

    Hager: I said, “You know, let’s hold off. Why don’t we get you enrolled in PALCO? Come on back in a couple of weeks.” At no cost to her I could then drain her knee. And then she ended up needing surgery and was able to have the surgery completely covered.

    PALCO is both a volunteer network of doctors and a consortium of hospitals that donate services to round out that care. Supporters say the program keeps uninsured people from going to the emergency room, which can be a very expensive way to get routine care.

    Manheim resident Jim Bamberger is a member of the PALCO advisory board, and a patient. Before PALCO, he says it was tough to get care.

    Bamberger: Many family physicians see patients for free — around here anyway — but then when you need to get laboratory tests done, there’s no way to get that done. If you need to see a specialist, there’s no way for that referral to happen, hospitalization was impossible.

    Bamberger was earning about $10,000 a year when he signed up for PALCO. The program is only for low-income, uninsured Lancaster county residents — who don’t qualify for Pennsylvania’s medical assistance program.

    Bamberger: Hardly anybody qualifies for medical assistance if they’re an able-bodied male. That’s true if you are an able bodied female too, if you don’t have children, or you’re not pregnant or something of that sort.

    Volunteer doctors from across the county agree to care for 10 to 20 patients in their own communities, and at their own offices. That structure distinguishes PALCO from other volunteer programs, where patients rarely see the same doctor every visit.

    Dr. Mary Wirshup leads the medical staff at a free standing clinic in Chester County. Community Volunteers in Medicine has a paid staff of 15, but most of the doctors come into the clinic to volunteer a few hours a week.

    Wirshup: You have to realize they might call and say their kid is sick that day. Like my one gynecologist just had open heart surgery. He’s out for awhile. You have to deal with those issues.

    Back in Lancaster, supporters says PALCO patients get consistent attention from the same provider.

    Marc Stier is the Pennsylvania director for Health Care for America Now. He’s skeptical.

    Stier: If you’re trying to see a specialist in some parts of the state you can wait a very long time to see someone, if you have the best insurance in the world. I don’t see how we are going to get people without insurance to see specialists by relying on volunteers.

    PALCO administrators admit that’s a problem. The network has a shortage of specialists including obstetricians and orthopedic surgeons.

    Berry Friesen is spokesman for the Pennsylvania Health Access Network. The coalition wants to overhaul healthcare in Pennsylvania, Friesen says the volunteer idea diverts attention from that goal.

    Just like food pantries are needed to make sure that people don’t go hungry. We do need charity in the medical field as well. But we don’t build our system around charity.

    The bill’s sponsor is Senator Mike Brubaker from Lancaster. He envisions a $4 million program administered by the state Department of Health, which would recruit doctors and the extra health services needed to provide comprehensive care.

    Brubaker says a volunteer network is just one idea in a larger Republican proposal to improve access to affordable health care in Pennsylvania.

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