Health Care Sparse For the Poor

Aired June 9, 1999

This is INFOhio After Nine, I am David C. Barnett, saying hello to you on this June 9th, 1999. We start off the hour, though, with the progress of other Clevelanders, Clevelanders who are directly affected by "The Changing Face of Welfare" in our community. Today's focus, in our year-long series on welfare reform, is on health care. The Cleveland phone directory holds 20 different listings for hospitals, and yet, in spite of the city's vast wealth of medical knowledge and facilities, it's all too easy to find neighborhoods in which the sick aren't getting the care they need, as hospitals continue to streamline operations. It appears that the options for Cleveland's working poor are on the decline. 90.3's April Baer reports on the shifting pattern of health care in Cleveland.

April Baer–Cuyahoga County's welfare clients have shrunk to a group of less than 20,000. By October of next year, 93% of that group must go to work. But as if these families don't have enough on their minds as they try to get off public assistance, they now face increasing uncertainty about where to look for health care. Most welfare recipients live within a few miles of a major hospital, but those who go in for treatment may find the menu of services is changing. Ted Board is a health industry attorney with Buckingham, Doolittle, and Burroughs.

Ted Board–A lot of the older hospital facilities are located in the poorer neighborhoods because they were built 50-75 years ago. Unfortunately, these older facilities are more cost-intensive to maintain, so as we see hospital facilities closing, we're probably going to see the older facilities close first, and they happen to be in the poorer neighborhoods. The one I cite for an example is St. John Hospital closed on 79th and Detroit 10, 12 years ago, but it was in a low-income area and it was a very cost-intensive facility to maintain.

AB–Last month, St. Luke's, a private hospital that's had a long-range commitment to serving Cleveland's indigent populations, announced a change. While the hospital's emergency room will remain open and fully functional, it's no longer going to accept trauma cases. That in and of itself may not mean much. The hospital management is planning to fill the gap in services by beefing up trauma care at its other holding, St. Vincent's. But Ted Board says the reduction is an example of a larger trend. The federal government pays hospitals to take care of welfare recipients and others in need on Medicaid. But over the past couple of years, Medicaid's payments to medical providers have been shrinking. Board suggests it's become a lot more profitable for hospitals to cut back acute care services and concentrate on the disciplines that will bring in more money.

TB–For instance, cardiology, they will set up cardiology hospitals, hospitals that are small, very efficient, and do nothing but cardiology, and the reason is that cardiology is one of the services that's still very willing reimbursed. You're seeing the large, acute care centers closing and failing, and you're seeing more of the outpatient, what we call doc-in-a-box.

AB–In some ways, Board says, the reshuffling of services was inevitable. He sees Cleveland as a town with too many hospitals, and too much funding invested in programs that were duplicated at several facilities. Metro Health Systems is home to what many consider one of the best-equipped trauma centers in town. It's also the city's only publicly-owned hospital, and another haven for welfare recipients or people who have recently worked their way off the rolls. Dr. Melinda Estes is Metro Health's chief-of-staff.

Melinda Estes–We certainly have seen a limitation of choices in the urban area for serving patients. As a result, we have seen an increase in our volumes, particularly in our emergency room, and we believe that people who were receiving their care at either St. Luke's or Mt. Sinai, that many of them are finding their way to Metro, so it clearly is impacting our business. We're much busier this year than last, and that trend has continued.

AB–Dr. Estes says in many ways the rivalry between hospitals has been beneficial. For one thing, it's encouraged Metro Health to come up with services, like its specialized burn unit that can benefit the whole region. But she says it's also clear that competition has led directly to some redundancy, with several hospitals offering services that one or two could have handled. The slow, gradual slimming of central city medical services hasn't gone unnoticed on welfare reform's front line. Marek House is a Tremont-based neighborhood center that provides services, including health advocacy, for low-income people. Marek executive director Gail Long says people on public assistance are trying to cope with an increasingly complex benefit system and often aren't even sure of what services they're entitled to. She says they often put off going to a hospital until their needs are critical.

Gail Long–I think that if people don't have a way to access care that pays for the care at the same time, that they're less likely to access it, unless they absolutely need it, in cases of an emergency.

AB–Gail Long says as the bottom line continues to be a rising influence on hospital decision-making, she wanted to be assured that as much money as possible goes back into direct services for a population that needs them the most. For INFOhio, I'm April Baer in Cleveland.