Do the poor die young?

Our nation continues to struggle with providing health care to the people who are on the lower end of the socioeconomic ladder.  Not being able to afford health care and not having health care coverage is a disaster, especially when you have a chronic condition.

My son, an internist, published an article, "Dead Man Walking," in this week's New England Journal of Medicine (Stillman & Tailor, 2014) describing several patients in his practice who had inadequate health care coverage.  This problem is widespread and exists, right here, in North Philadelphia.

To address this problem in North Philadelphia, Temple University Health System, has trained and employed a number of Community Health Workers (CHWs) to help this defenseless population.  The CHWs are highly motivated individuals from our community who undergo an intensive five week training program and then are asked to serve as liaisons between our highest cost, highest risk most vulnerable patients and their health care providers.  We assign the CHWs to patients with chronic illness who do not have a primary care physician, are frequently admitted to the hospital and use the emergency department instead of visiting a physician's office for non-acute health care needs.

There are many patients in the Temple University Health System who have benefited from this type of intervention.  One example is a patient who came to the emergency department with chronic heart failure, was fluid overloaded, did not have health insurance and did not have enough money to pay for his medications.  Over the course of six months, the patient had been admitted to the hospital five times. The patient was homeless and after his most recent discharge, he was directed to a medical assistance office where he was given 3 months of health care coverage.  When he failed to show up for follow up appointments, his health coverage was discontinued.  He went to a city health center to receive medications and was only given a short supply. When the patient ran out of medication he returned to Temple Hospital Emergency Department for care.

This patient was then assigned to one of our CHWs who immediately re-enrolled him in a medical assistance program.  From there, she began reaching out to community resources to ensure he had temporary housing.  She continued to visit the patient, check and make sure he was eating correctly and ensured that he had transportation to his scheduled follow up appointments.  She was also able to sign him up for a program that supplied him with free medications.  With this intervention by the CHW, this patient has remained out of the hospital for the past three months.

A second example is a patient who had breast cancer six years ago and was treated with radiation therapy, a lumpectomy and was declared to be cured.  Over the past year, she had been worrying that something might be wrong.   Her minimal health care coverage concerned her far more than her symptoms and she delayed scheduling an appointment.  Eventually her symptoms became so intense that she visited the emergency department and was found to have metastatic disease throughout her body.  If she had not been worried about her health care coverage and had an earlier intervention, her prognosis would have been greatly improved.  She was assigned to one of our CHWs, who is helping her navigate the system and receive the care she needs.

Many are arguing that the Affordable Care Act is flawed and too costly.  However, for people like the patients mentioned above, affordable health care means they get the opportunity to live longer and healthier lives.  It means that maybe they don't have to die young.

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