The cost of health care is beyond the reach of many Virgin Islanders, but from time to time these residents still have to see a doctor. At Juan F. Luis Hospital, a program is in the works to resolve that issue in a way that provides the service needed when it’s needed, and in a more efficient way.
Healthy Access, the program designed to provide more efficient medical service, was the topic of a "town hall" meeting Thursday night. About a dozen community members along with members of the hospital staff gathered in the conference room of the V.I. Cardiac Center to discuss the idea.
The program’s planners are hoping to unveil it by October, and while Dr. Robert Centeno said there are plenty of details to work out, "It’s not like we have to reinvent anything. There are lots of successful models of these programs in the states."
In the last three years the hospital spent $75 million providing medical care for which it was never paid.
People with low incomes and no insurance don’t usually have primary care physicians. Instead they wait until they have a problem so severe they have to go to the emergency room. The Luis emergency room sees about 20,000 patient visits a year, and many of those are people who haven’t seen a doctor.
Many of them can’t pay for the service, which the hospital is required to provide, Centeno said. And often these patients are being treated for something that, had it been caught earlier at a doctor’s visit, would have been treated more easily and less expensively, Centeno added.
"It’s about making sure our patients get the right treatment at the right time," he said.
A patient seeing a health care worker during a normal visit or consultation, for instance, might learn that his swollen feet and shortness of breath are indications of a heart problem and begin treating it with diet and exercise, rather than waiting until chest pain drives him to the emergency room where he learns he has a degenerative heart disease.
Healthy Access is an attempt to draw on the good will and the dedication of the medical community to provide the most appropriate treatment to the low-income segment of the population. It’s a national model that is widely followed across the U.S.
As the nonprofit program is envisioned, doctors, labs, pharmacists and other interested health care providers would donate services to the program. It would be open to residents of the territory who earn no more than 200 percent of the national poverty level and are otherwise not covered by Medicare, Medicaid or any other such insurance program.
To the question of "How can we afford it?" Centeno replied, "How can we afford not to?"
With economic problems and the rising cost of insurance, the medical community will continue to be pressed for services, and Healthy Access would provide a way to offer it, he said.
"The whole idea of the physician being the steward of the health care system is in play."
Jeff Nelson, chief executive officer of the hospital, noted that it’s a work in progress, but the bare bones of the project are in place. The hospital is just one of the potential partners, he and Centeno both noted, and the final project will be shaped by the people who choose to participate.
During the audience discussion, retired nurse Verna Christian-Garcia, president of the V.I. State Nurses’ Association, said the project does not require government approval and its potential is limited only by the donations of the medical community. She urged the hospital to go full-speed ahead in implementing the program.
