September 11, 2007

Health Care Access

I continue to be disappointed by the incompleteness of the discussion of issues in the national health care debate. There is abundant discussion of coverage and affordability, considerably less coverage of preventive and wellness, almost no discussion of what is needed to assure adherence to required treatment programs for chronic diseases, and little discussion of the issue of access gaps.

Everyone associates unnecessary emergency room visits with lack of insurance coverage. Certainly, many people in emergency rooms are individuals lacking insurance coverage. However, there are many people who have relatively minor illnesses or injuries, but who go to emergency rooms because they incur their medical condition after their primary physician’s office closes for the day or on a Sunday, when their physician’s office is most likely closed.

The first question we need to ask is why physicians have office hours comparable to the hours of business for American retailers over 40 years ago. The main reason is that the majority of medical practices are either sole practitioner or small groups, with little ability to provide Sunday or late evening coverage.

Beyond that, there simply are many areas that do not have what we have in Stamford, Connecticut, an urgent care center that is open seven days a week, the Tully Center, which is part of the Stamford Health System. I have been in communities as diverse as downtown Chicago, downtown Los Angeles, and King of Prussia, Pennsylvania, that have had no non-hospital-based urgent care facilities for minor illnesses and injuries.

To some degree, the problem is the economics of urgent care in some states, with shortages of physicians, nurse practitioners, and nurses that could staff such facilities. In addition, with such a complex issue as health care, state and local government officials may not be able to focus on the specific problem of after-hours care, nor propose the solutions that could mean higher quality care at a lower cost, which most well run urgent care centers provide. The primary care physicians may also not favor having to address patient issues that may arise from another provider.

At Pitney Bowes, we have effectively operated an urgent care clinic inside many of our facilities. Our clinics treat minor illnesses and injuries to avoid the problem of employees leaving the office for several hours to go to an outside appointment. We also do preventive screenings and immunizations, and we help refer employees to specialists, with the cooperation of their primary care physicians. We work closely with the primary care physicians in the community to make sure we provide a complementary service, not a competitive one.

We also provide space inside our facilities for specialists who have many employees as patients, and enable them to see many patients in a more focused and shorter period of time than they would in their offices.

There are other access gaps in the health care system, such as the shortage of home health nurses and geriatricians, or the emerging shortage of primary care physicians in some communities.

I do not see how we can attack cost-related issues associated with coverage unless we also come to grips with these access gaps.