Healthcare for the hard-up
—Terray Sylvester, High Country News
A $40,000 hysterectomy: $700. Basic X-ray: $10. Dental cleaning: $45. Intensive care unit: $600 per day.
The Access to Healthcare Network’s prices sound like a doctor’s bill from the 1950s or ‘60s. So it’s not surprising that the Reno-based nonprofit—which provides affordable, comprehensive healthcare to the uninsured working poor in Washoe County, Nevada—has seen its membership swell to more than 2,500 people since it opened in 2007. Director Sherri Rice expects another 2,500 to join by the end of this year.
“We are in such a healthcare crisis in our country,” Rice says. “Hospitals and the uninsured want to look for a new way.”
The Access Network operates on one basic principle: shared responsibility. Its roots go back to 2004, when a group of local stakeholders, including two big hospitals and the county and state health departments, began looking for a sustainable way to provide service to some of the community’s poorest people. According to Rice, they weren’t interested in “another entitlement program” such as Medicaid, which relies on federal and state funding and doesn’t require patients to put much money or effort into their own care.
Now, the two hospitals and more than 450 other healthcare providers have agreed to offer their services at low fixed rates. In exchange, the Access Network guarantees that its members will pay cash at the time of service. It pairs each member with a “care counselor” who ensures that medical appointments and follow-up care will be handled responsibly.
It’s a good deal for the providers—which range from pharmacies to acupuncturists, optometrists to cardiologists—because it allows them to serve needy people with the assurance they’ll get some payment without a protracted collection effort. The hospitals are also able to cut down on their charity expenses. (Patients who can’t afford specialty services or coherent care often end up in emergency rooms, and hospitals are frequently stuck with the bills.)
“We put structure to a structureless population,” says Rice. “We have proved that people at poverty line can pay.”
Nevada residents who earn between one hundred percent and 250 percent of the federal poverty level are eligible. Aside from the fixed rates they pay to providers, they pay a monthly fee to the Access Network: $45 for an individual, $90 for a family. Some small-business owners help employees by paying a portion of the fees.
Rice has only expelled ten members for failing to pay. No one, she says, has asked for free service. “They ask to pay what they can according to income. They ask for their dignity. We give them both.“
The Healthy Geezer
Q: My daughter heard that grapefruit juice can be toxic for some people. Is that true?
A: The juice, itself, is not toxic, but you should be careful taking medicine with any grapefruit.
Grapefruit juice can raise the level of some medications in the blood. The effect of grapefruit was discovered after using juice to mask the taste of a medicine. So, be sure to ask your doctor or pharmacist if it is safe to have grapefruit with your medications.
Taking medicine can be hazardous to your health. You have to know what you’re doing. For example, calcium-rich dairy products or certain antacids can prevent antibiotics from being properly absorbed into the bloodstream. Ginkgo biloba can reduce the effectiveness of blood-thinning medications and raise the risk for serious complications such as stroke.
You should educate yourself so you know what active ingredients are in the prescription and over-the-counter medicines you are taking.
Some people treat over-the-counter pain relievers as if they are harmless. They can hurt you if you take them improperly. They contain drugs such as acetaminophen, ibuprofen, naproxen sodium, and aspirin. Acetaminophen is in Tylenol. Ibuprofen is in Advil. Naproxen sodium is in Aleve.
Many prescription or over-the-counter medicines that treat multiple symptoms, such as cold and flu medications, also include acetaminophen and the other pain-relieving ingredients. So you have to be careful not to take too much of any one ingredient by ingesting more than one medication that contains that ingredient.
Seniors take more medicines than any other age group because they have more health problems. Taking several drugs a day presents dangers. Here are some tips to help you avoid these hazards:
Always inform your doctor or pharmacist about all medicines you are already taking, including herbal products and over-the-counter medications.
Tell your doctor, nurse, or pharmacist about past problems you have had with medicines, such as rashes, indigestion, or dizziness.
Don’t mix alcohol and medicine unless your doctor or pharmacist says it’s okay. Some medicines may not work well or may make you sick if you take them with alcohol.
The best advice is this: Don’t be afraid to throw a lot of questions about your medicines at your doctor, nurse, or pharmacist. Here are some good ones:
- When should I take it? As needed, or on a schedule? Before, with, or between meals? At bedtime?
- How often should I take it?
- How long will I have to take it?
- How will I feel once I start taking this medicine?
- How will I know if this medicine is working?
- If I forget to take it, what should I do?
- What side effects might I expect? Should I report them?
Can this medicine interact with other prescription and over-the-counter medicines—including herbal and dietary supplements—that I am taking now?
Also, ask your pharmacist to put your medicine in large, easy-to open containers with large-print labels.
If you have a question, please write to firstname.lastname@example.org.