St. Louis — The recession has driven consumers to cut back on their spending, but there has been no shortage of patrons where Abbe Sudvarg works.
Instead there have been more — thousands more — who want to purchase the services offered at Family Care Health Centers, where Sudvarg is a family practice physician. And the flood of patrons is more than the clinic, which specializes in low-cost health care, can handle.
"We cannot expand to fit the need," said Sudvarg, who works at the center’s 401 Holly Hills Avenue location.
Area community health centers, a large chunk of the health care safety net that serves the uninsured and underinsured, have been strained by a major boost in business during the past year. The uptick comes as jobless rates spike and more people lose their employer-based health insurance.
In 2007, more than 215,000 St. Louis area residents used local safety net providers, which include county health care centers, clinics based in hospitals and medical schools, "free standing" public health clinics and federally qualified health centers such as Family Care. There are 23 sites in St. Louis and St. Louis County.
Family Care’s list of patients grew in 2008 by 14 percent, or about 2,500 patients. Robert Fruend, CEO of the St. Louis Regional Health Commission, which works with the area’s community health centers, said nearly all the region’s clinics have seen significant increases recently. The Southern Illinois Health Care Foundation also reported a patient increase at 26 clinics in the Metro East area, including a 24 percent jump, or 8,006 people, in the number of uninsured patients.
Alan Freeman, the president and CEO of Grace Hill Neighborhood Health Centers in St. Louis, said patients’ stories have become more desperate. The numbers of homeless and newly unemployed patients at Grace Hill have risen dramatically in the past 18 months, he said.
"The bottom line is there is a greater number of uninsured patients, and it’s increasing," Freeman said.
For the growing group that depends on the health centers for anything from eye care to podiatry, officials said, the increased demand could mean longer waits to get appointments. Fruend said the financial strain could reverse some of the recent progress at St. Louis area sites toward keeping wait times down, especially for meetings with specialists.
"If it’s your wife with the lump in her breast and she’s getting in in a timely fashion rather than waiting months, it’s huge," Fruend said.
At Family Care, Sudvarg said, it is becoming more difficult to take new patients. The center doesn’t want to sacrifice quality by accepting more patients than they can handle, she said.
"Everyone’s priority here is to make sure we do it right," she said. "Unfortunately, that means we would rather turn people away than start doing it wrong payday loan lenders."
Connie Hodges, who visited Family Care’s location on Holly Hills last week, said she and her son, James, have depended on the center for 15 years. Hodges, 48, of St. Louis, said she has never been able to afford health insurance for an extended period of time, and a community health center was her only option besides avoiding treatment.
"I didn’t have to make a choice between feeding James and taking my medicine," she said.
The price charged to Hodges, who joined the center’s governing board as a "consumer" member three years ago, is based on her income. She has always paid much less than she would at other providers, but the board, faced with serious budget problems, recently voted to raise its prices.
"(The minimum charge) is going up from $15 to $20" a visit, she said. "That’s going to affect me."
At these centers, more patients don’t mean more money. Treating uninsured patients, which make up the bulk of the new clientele, is costly because the patient fees are usually far less than the cost of their care.
Grants and government funding subsidize most centers, but local and national health care officials say revenue hasn’t increased to meet the rising need. State governments and grant-giving foundations also are seeing shrinking budgets because of the economic downturn, and some are cutting back on support for the health centers, said Georges Benjamin, executive director of the American Public Health Association.
"Just when we need the safety net, the resources that fund the safety net are getting cut," Benjamin said.
There is some hope that help could come from the federal government. Barack Obama’s nominee for secretary of the Health & Human Services Department, Tom Daschle, has said he supports increasing federal funding for the centers to $8 billion from $2 billion. Senate Democrats also have advocated including money for the centers in the economic stimulus package that Congress is considering.
But to deal with the current strain, some clinics are cutting staff or employing other tactics to improve efficiency.
Family Care has frozen the salaries of its employees for the upcoming fiscal year, and director Bob Massie said budget issues kept the center from adding another physician to the staff, even though there was more than enough demand to justify the hire.
In an attempt to make all the city’s clinics more efficient, Fruend said, the Regional Health Commission has been working to streamline the exchange of information between centers, find inexpensive supplies for the office and reduce "back office" staff, which do jobs such as billing.
But while he said he’s been pleased with the efforts to make the safety net more efficient, Fruend said there is not much more that can be done without affecting access to care.
"It’s getting tight out there."
jcrawford@post-dispatch.com | 314-340-8349
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