Access to health care a problem in the U.P., other rural areas

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Capital News Service
LANSING – Sixty-one-year-old Julie Fleury of Marquette had health insurance when she was young and needed only the occasional physical exam.
But when she separated from her husband, she lost that coverage
She was still uninsured when she discovered she had melanoma. The consequent cost of treatment drove her into bankruptcy.
“I had checked into various places that I could possibly get some health insurance, and there was nothing I could afford,” she said in an interview with the nonprofit Medical Care Access Coalition in Marquette, posted on YouTube. “It was out of my reach.”
The coalition provides health care for low-income and uninsured residents of Marquette, Alger and Schoolcraft counties.
Residents like Fleury of the Upper Peninsula and other rural parts of the state are struggling more than their urban counterparts when it comes to health care access, according to a study by the Center for Healthcare Research & Transformation in Ann Arbor.
The study reported that “urban dwellers, despite having the lowest average incomes, had fewer problems with access to care” than rural residents.
“The reason is that there simply aren’t as many safety-net providers in those communities,” said Marianne Udow-Phillips, executive director of the center. “For example, programs like community heath centers and free clinics tend to be much more common in the urban parts of our state like Detroit or Grand Rapids.”
Udow-Phillips said that the prevalence of small businesses in rural areas contributes to the difficulty in access.
“What we find in general is that small businesses are much less likely than are larger businesses to provide health insurance,” she said. “In the U.P. you tend to see much more agriculture and many more people in small business. They’re less likely to be employed by someone who does provide health insurance.”
Jerry Worden, chief financial officer at Marquette General Hospital, said that the hospital budgets money to treat patients who either cannot afford care or are uninsured.
“We have a financial assistance policy where we ask them to fill out applications to qualify them for financial assistance,” he said. “Anyone who is within 200 percent of the poverty level and doesn’t have any substantial funding would qualify.
“It’s part of our mission,” he said. “It’s part of our cost. For example, we have a technician that provides a CAT scan, and that scan is not reimbursed. It becomes part of our cost structure.”
Heather Dombrowski, development coordinator with the Medical Care Access Coalition, said that “being uninsured generally means delaying care until it’s at a critical point for their health. We have many people enrolling that have reported not seeking care when needed because of cost.
“Our programs work to fill the holes that people fall into and work with health facilities to make sure that we do not duplicate services,” she said.
For example, the Luce-Mackinac-Alger-Schoolcraft (LMAS) District Health Department has offices in each county. It offers services such as immunization, cancer screenings, hearing and vision screenings for children, as well as check-ups, STD testing and communicable disease treatment, said Nick Derusha, the LMAS health officer.
“Uninsured and under-insured, we still provide services to them,” he said. “There’s a significant number of them that either do not have insurance or their deductibles or co-pays are so high they qualify as under-insured.”
Derusha said that the department can afford to serve people who can’t pay because of funding from the state and local appropriations.
Unfortunately, that money still isn’t enough, Derusha said, so the department has eliminated several projects, including a maternal infant health program.
“We had mothers, expectant mothers and very young children coming in and we’d provide nursing visits with them and nutrition education from a registered dietitian,” he said. “We’ve heard from quite a few folks that they miss the program.”
Similarly, the department dropped a substance abuse program.
Derusha said that distance between communities is also a problem.
“We have only 34,000 people and we’re spread across 10,000 square miles,” he said. “We have a little over an hour between our four offices.”
Udow-Phillips of the Center for Healthcare Research & Transformation and Dombrowski of the coalition agreed.
“There are travel issues,” Udow-Phillips said. “With the distance and concentration of health centers, it can take a long time to get to what you need. It tends to be a problem in rural areas, even in the Lower Peninsula.”
“Transportation is an issue here,” agreed Dombrowski. “There’s little to no public transportation, which makes it virtually impossible to access care.”
Worden said that Marquette General may look into a public transportation program similar to one being established in the Sault Ste. Marie area.
“They have a volunteer transport system out of Sault Ste. Marie to take patients down to Petoskey for radiation therapy and that’s staffed by volunteers,” he said. “We need something more like that across the Upper Peninsula.”
Even residents with insurance may still hesitate to seek care, according to the center study, citing rising deductibles and diminishing funding from programs such as Medicare.
“People are having a hard time affording just a portion of care,” Udow-Phillips said.
For now, people like Julie Fleury in Marquette are relying on organizations such as the coalition and health departments like LMAS. But it’s not enough.
“Not being able to be insured in Michigan has lead me to bankruptcy,” she said to the coalition. “And that’s where I sit. I don’t know what’s going to happen with me next.”
© 2010, Capital News Service, Michigan State University School of Journalism. Not to be reproduced without permission.
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