CITY HEALTH CLINICS NEED A BOOSTER SHOT

THIS WEEK, City Council heard budget testimony from Dr. Donald Schwarz, deputy mayor for health and opportunity and city health commissioner.

Each year, the department spends $45 million to operate 10 public health centers across the city. These facilities are open to anyone who lives in Philadelphia, but are primarily used by low-income individuals and people without health insurance. Council has been pushing for increased funding for the centers for several years, and Mayor Nutter's budget proposal includes an additional $3 million to keep the centers open later and hire more staff.

Consider: Ten health centers, with a budget that is about 1 percent of the total city budget, provide critical medical services to thousands of Philadelphians, and are often the last resort for many residents without insurance. (In comparison, there are twice as many police stations and six times as many firehouses.)

Are we paying enough? Too much? This is especially important to ask as states, like Pennsylvania, and presidential candidates grapple with the larger question of how to provide health care to the many millions who are uninsured.

How they work: The health centers (found under "Ambulatory Services" in the mayor's operating budget) provide comprehensive care to anyone who lives in Philadelphia. Residents can visit a doctor for a routine checkup, see a dentist about a toothache or fill prescriptions at the pharmacy. Patients can also get blood tests, family-planning counseling and a variety of other health services. Doctors also provide referrals to specialists, like a neurologist or internist, for people who need special types of care.

The centers provide services even if a patient is uninsured or can't pay. They do accept payment - most insurance plans, Medicaid, medical assistance - and offer a sliding scale based on income. The pharmacies subsidize the cost of prescriptions.

Philadelphia Health Management Corp. estimates that there are 137,000 adults in Philadelphia without health insurance. For many, visiting a city health center is the only way to get access to comprehensive medical care.

People without insurance can visit an emergency room, but the city centers are a better option for a variety of reasons.

FIRST, HOSPITAL visits aren't free. The average cost of a visit to the emergency room is $1,049, and most hospitals bill patients regardless of their ability to pay.

Second, most emergency rooms only provide life-saving treatment to people without insurance. In contrast, the city centers provide ongoing treatment and allow a patient to make multiple visits to the same doctor over a long period. This kind of care is much more likely to identify and address health issues before they become life-threatening.

How they don't work: The system is far from perfect. According to a report released by the Philadelphia Unemployment Project last year, it can take up to five months to schedule an appointment with a doctor at a health center. Advocates say the centers need to extend evening hours and add staff to shorten waiting times. The mayor's proposed funding increase is supposed to deal with some of these issues.

One of the biggest challenges that health centers face is offering competitive salaries to attract qualified staff.

The salaries offered by the city for three critical positions - pharmacists, dentists and physicians - are relatively low when compared to industry averages.

The highest-paid pharmacist working for the city makes $77,013 - well below the national median of $103,000. The same is true for dentists who work for the city. A typical dentist makes $130,000 a year. That's significantly more than the $95,630 made by the highest-paid dentists at city health centers.

The largest discrepancy can found in the salary paid to doctors. The average physician working in a family practice makes $204,000. The highest-paid physician working for the city makes $109,820 - a difference of more that $94,000.

Some bigger questions: When we look at the statistics in the accompanying chart, we can't help thinking that the city has figured out a pretty cost-effective way of providing health care to people who need it.

Based on our rough math, for example - and, yes, we know that health-care quality goes beyond simple math - patients are averaging just over three visits a year, for an average cost of visit of $149.

That means that we're paying $450 a year to provide health care to low-income people. Compare that with the price of a typical insurance plan, which can cost thousands of dollars a year per person.

Of course, that figure is only a small part of the picture: We don't know how often those patients should be seeking medical attention, we don't know if they are ignoring chronic diseases that ultimately cost far more in hospitalization costs, we don't know how many more who need medical attention are not visiting the health centers.

But strictly from the It's Our Money standpoint, we'd say that increasing the budget for the health centers would be a wise investment. *

Ben Waxman covers budget issues for

It's Our Money, a partnership between the Daily News and WHYY funded by the William Penn Foundation. Find the site, with further discussion of health centers, at www.ourmoneyphilly.com.