Health Care


Recently, the Partnership for Prevention, an organization that is trying to promote prevention and wellness as key health care strategies, issued a report entitled A National Profile on Use, Disparities, and Health Benefits.

The value of preventive care is clearly demonstrated by the Report. Most interesting is the fact that, with respect tochildhood immunization, an area of strong public policy focus, disparities based on race, ethnicity, and income have largely been eliminated. However, for other areas, like the taking of aspirin to prevent heart disease, adult immunization, colo-rectal screenings, and smoking cessation, there are huge disparities among races, ethnic groups, and income levels.

Medicare inadequately covers these treatments, but, beyond that, there has been inadequate focus on what the obstacles to adherence to recommended prevention and wellness approaches might be. Coverage and cost are certainly issues, but there are basic access gaps in our health care system.

For example, in New York City, our Management Services employees tend to work in Manhattan during the day, but live in the outer boroughs. Even if they have primary care physicians, those physicians do not tend to have evening and weekend hours, with the result that these employees use the emergency room for after-hours care. Emergency rooms are extremely hostile to people who use them for preventive screenings or immunizations. I know, because years ago, I needed to go to a medical facility to get allergy injections, and I was told that I did not belong in an emergency room because the ER was for life-threatening conditions, not for preventive care.

But where should these employees and their families go after hours if they want to get a screening or an immunization? In many communities, walk-in clinics that provide these services simply do not exist. In New York, there are three walk-in clinics at Duane Reade drug stores, all in Manhattan, and all in high-income areas, not in the outer boroughs where these employees live.

Recently, my son and I were in King of Prussia, Pennsylvania, a considerably wealthier suburban area than many in the United States. He had a minor illness that required a medical facility visit. No walk-in clinic existed in that area. I have also had the same experience in Chicago and Los Angeles.

There is a serious gap in our health care system in terms of basic care outside people’s normal working and school hours. Preventive care tends to be the first casualty of this gap.

Walgreen’s has a mobile van which travels from city to city on its Wellness Tour, and pharmaceutical companies, from time to time, have put together mobile screening programs. However, we need a more permanent, comprehensive network of preventive care capabilities that can be accessed outside normal working hours, to serve people where they live.