Health-care access is growing problem

Hospitals around the country are grappling with new ways to solve an old problem — the inability of large segments of the population to afford health-care coverage and their subsequent reliance on emergency rooms when their conditions devolve to a crisis.

They're not all the poorest of the poor, many of whom can access a variety of crisis programs, including Medicaid, hospital charity care programs and certain public health clinics.

Rather, they are those who fall into the cracks, including working poor who make slightly too much to enroll in government programs, single individuals who are cut out of such programs (rules for the programs vary from state to state) and those who simply cannot afford premiums for a variety of reasons or for whom health insurance is not offered.

As the cost of providing insurance rises, those numbers are growing. A lot of employers are abandoning health coverage because of cost.

Absolutely nothing indicates that it's a problem that's going to decrease. The trend for the number of uninsured is in an upward direction, with the latest estimate 46.6 million Americans. That's nearly 1 in 6, given we just passed the 300 million American milestone last week.

But some efforts are being made. For instance, Wednesday, the New York Times reported that several hospitals in central Texas are experimenting with providing basic, preventive services to people who have been expensive users of crisis care such as emergency room services. They're focusing on people with chronic conditions. Instead of waiting for a brittle diabetic to have a serious medical emergency, they're hooking those individuals up with primary care, and diabetes-maintenance services, for example.

And they say they're saving money while they do it.

In New York, more than 2,000 people who would otherwise fall in the cracks have been assigned to primary care doctors for basic preventive care. Massachusetts mandates that employers make basic insurance coverage available.

Those of us who have adequate insurance, barring absolute catastrophe, may not realize that there's a quiet revolution going on as insurance companies, government-sponsored programs and others look for ways to curb the increase in health-care costs.

This week, during the gathering of the American College of Chest Physicians at the Salt Palace, the keynote address looked at some of the efforts to wrestle with cost issues of care. But it warned that you can't look at cost if you don't also take into account the quality of the care that's being provided.