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Tuesday, January 15 , 2019, 8:00 pm | Overcast 54º


Cynder Sinclair: Implementing Health-Care Reform at Home

Santa Barbara Neighborhood Clinics serves as a model for low-cost, high-access services

Community clinics, such as Santa Barbara Neighborhood Clinics, are poised to play a significant role in implementing the recently enacted federal health-care legislation. Today, these clinics are bursting at the seams as more and more people find themselves out of work or without insurance.

The Wall Street Journal reports that soon, community clinics around the country will be serving an additional 20 million people and showing the way forward by increasing access and decreasing cost. The health-care overhaul includes the largest expansion of Medicaid since its inception. And, since many private doctors don’t accept Medicaid, community clinics provide the critical health safety net for hundreds of communities throughout the country.

A recent study by George Washington University shows that community clinics save the federal government $24 billion a year. Cost savings also come from keeping people out of emergency rooms.

Community-clinic patients are usually living well below the federal poverty level, which is one reason most private medical facilities don’t serve them. The sliding fee scale used by community clinics makes it possible for even the poorest patients to maintain their dignity by paying something for their care. Undocumented workers find a safe haven at community clinics because clinicians are more interested in treating patients based on health needs than on immigration. Community clinics are mission-driven and led by passionate practitioners who feel part of a movement for equal access for all in addition to being a place where sick individuals are healed.

Today, many are asking which is more important, access to health care or the cost of providing it? It’s both. We need a health-care system that streamlines access for all people in a cost-effective manner.

Santa Barbara Neighborhood Clinics is serious about both access and cost. It diligently removes barriers to access to high-quality health care, dental care, mental health services and prevention education. Its unique circle-of-care approach to health-care delivery proactively addresses the needs of the person and the community as a whole. Each patient is treated with dignity and respect as clinicians proactively explore ways of improving each patient’s overall well-being. Thanks to the success of removing barriers to access, Santa Barbara residents can be proud of living in a community where every person has access to health care — regardless of ability to pay.

What about cost? When most people debate the issue of health-care cost, they are referring to the overall cost in terms of impact on the country’s budget. While this is an important discussion, “real” cost begins with the service delivery model — or the degree of cost effectiveness at the initial point of service.

An extreme example would be to compare the cost of delivering service to an indigent patient in a hospital emergency room vs. delivering the same service in a community clinic. The Wall Street Journal reports that hospitals around the country are being forced to drastically cut their budgets, even to the point of reducing their medical staff, because of the high cost of treating the uninsured and underinsured in their emergency rooms.

By contrast, community clinics such as SBNC deliver excellent health care in a cost-efficient manner significantly below the cost of other health-care providers. It costs SBNC an average of $154 for each office visit. However, at an average reimbursement rate of $65 per visit, SBNC’s predicament is similar to the one many hospitals are experiencing. Thankfully, individual donors, businesses and foundations make up the difference between cost and reimbursement to ensure that SBNC’s doors are always open to those in need. The fundraising totals nearly $2 million each year. It’s truly inspirational to see generous donors, dedicated clinicians and committed staff working together to make sure that no one in Santa Barbara goes without health care.

While this model may not yet exist in every community in the country, at least it exists in Santa Barbara. Hopefully, many others will see the potential benefits and follow suit in the near future, and other communities are welcome to replicate it.

Some might say SBNC’s business model is unsupportable because of the $89 gap between reimbursement and cost. Some may say that it can’t be used as a model for the country because the only reason it works in Santa Barbara is because of generous donors. They might be partially right. However, if governmental funding sources did nothing more than make up the $89 gap between cost and current reimbursement, the country would be spending billions of dollrs less than the current plan calls for — and then this model could be replicated all over the country.

As people align themselves on one side or the other of the contentious debate over health-care reform, something beautiful is happening everyday in the neighborhoods of Santa Barbara — thousands of patients are finding the care they need. Clinicians and staff are lovingly providing a medical home for hundreds of families, especially the most vulnerable.

Say what you will about health-care reform, but SBNC is shining the light into the future of low-cost, high-access health care for our community, our state and for our country.

— Cynder Sinclair is executive director of Santa Barbara Neighborhood Clinics.

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