Private health care recipients face some turbulent times as they switch from fee-for-service to managed health care. But don’t expect any sympathy from the county’s vast population of uninsured.
According to local health officials, L.A. County is home to 2.7 million people with no health insurance the largest population of any city in the nation. And that number is expected to grow to 3 million by the year 2000.
Many of those poor are undocumented or have low-paying jobs, which often makes them ineligible for government-provided health insurance from Medi-Cal, the state’s program of health care for the poor.
That vast uninsured population faces many obstacles to receiving health care, but most of them are related to two assets the working poor can ill afford: time and money.
Money has become less of an issue for many uninsured Angelenos in recent years, thanks to a host of public and private clinics around the county that now offer free or highly subsidized care.
Time, however, is still one resource that most working uninsured can ill afford.
Even scheduled doctor appointments at community clinics can take hours, and unscheduled visits to the emergency room or specialty clinics often require an entire day, or longer.
The result: Many of L.A.’s uninsured put off seeing a doctor until they can no longer cope with a medical problem, said Brian Johnston, president of the L.A. County Medical Association.
“Most of the time they just don’t get any care,” he said. “They go in when something is so painful they just can’t work. And if they have children, they just don’t go in at all.”
Health care access for the uninsured varies widely, but the biggest divide comes between their access to generalist and specialist care.
While access to general practitioners is better now than a decade ago, the uninsured still face a daunting uphill battle when it comes to specialty care for chronic problems, such as cancer or diabetes.
Much of the improved access to general care can be credited to L.A.’s growing system of public- and private-funded clinics, which provide both continuity of care and affordable fees for the uninsured, according to Susan Fogel, legal director for the California Women’s Law Center.
“The public-private partnerships (i.e. public and private clinics) have produced mixed results. Many patients are seeing better access to primary care,” she said.
But for uninsured people who don’t belong to a clinic, the choices are walk-up appointments at neighborhood clinics or a trip to the hospital emergency room, which entail much longer waits.
“If they walk in (to a community clinic), they’ll often have to wait for many hours,” said Fogel.
At emergency rooms, the wait can be even longer for patients whose situations aren’t critical or life threatening, said Mario Molina, president of Molina Medical Centers Inc. in Long Beach.
“For smaller problems, a lot of the uninsured will go to emergency rooms, which route them to county hospitals,” said Molina. “Then the county hospitals will make them wait all day to be seen in their clinics.”
Molina said the wait becomes even more dramatic when it comes to seeing a specialist.
He recalled one case when an uninsured woman needed to have her tonsils out. After waiting all day in the emergency room at L.A. County-USC Medical Center, she was finally sent to the hospital’s ear-nose-throat clinic and got an appointment to come in another day.
“She eventually got her tonsils out, but she had to miss two days of work to do it,” said Molina, adding that many of L.A.’s working poor cannot afford to take that amount of time away from work. “If you have a specialty problem or need an operation and you’re uninsured, it’s very difficult.”
Molina’s example was echoed by other public hospitals in L.A. County.
For example, the average wait to get in to see an ophthalmologist at County-USC in 1995 was 22.6 weeks, while the average wait for an orthopedic doctor at L.A. County-Martin Luther King Jr.-Drew Medical Center was 25 weeks.
Access to specialty care has improved a little for those who access such care through the community clinic system; however, waits are still extremely long for those who go directly to specialists at county hospitals, said Fogel.
One example of the growing number of clinics that have developed their own referral network of specialists is California Kids Healthcare Foundation, a charitable organization that provides premium-free health care for children.
“For anything like this (comprehensive system of health care for the poor) to work, you need a system that will provide not only a primary care physician but also specialist referrals,” said the foundation’s executive director Mike Koch.