Q&A: Quick facts on valley health care problems

11/20/2007 12:00 AM

11/20/2007 6:47 AM

Q: How many people in Stanislaus, Merced and San Joaquin counties are eligible for Medi-Cal, the federal and state health care program for low-income people?

A: As of April, more than 300,000 people in the Northern San Joaquin Valley were eligible. Many more had no insurance.

Q: Who are they?

A: Most do not fit the stereotype of the homeless or drug users. They are the working poor whose employers don't offer health care, people who become sick and lose their jobs and health benefits, and young people starting out who don't feel they can afford insurance. Illegal immigrants, for the most part, do not qualify for Medi-Cal or Medicare. They can get treatment for medical emergencies and pregnancy, but otherwise are ineligible.

Q: Why don't doctors want to take on new Medi-Cal patients?

A: Government reimbursement rates don't come close to covering the cost of service. Most doctors do see some Medi-Cal patients, but are reluctant to take more.

Q: Why is there a shortage of doctors in the Northern San Joaquin Valley?

A: For a variety of reasons, young doctors choose other areas to practice. The reasons include career opportunities for spouses, cultural and educational opportunities, proximity to a medical school, finding a large enough patient base for a specialty, and the pay level.

Q: Why are the emergency rooms at area hospitals so crowded?

A: Uninsured and underinsured patients sometimes can't get access to a doctor, especially if they need to see a specialist. One of their only options is to go to the emergency room, even if the problem is not an emergency.

Q: Why are hospital costs so high for privately insured patients?

A: Hospitals take in a number of uninsured patients and "cost-shift" -- charging private insurance patients more to make up for the loss. This leads to higher insurance rates, which in turn cause employers to drop coverage of workers, who then become part of the uninsured problem.

Q: Why is the incidence of chronic disease so prevalent in the San Joaquin Valley?

A: There are many factors, including lifestyle choices, poverty, education levels, substance abuse problems and environmental factors. County public health officials are combating the problems with community-based education programs.

Q: Who provides health care for the uninsured and underinsured?

A: Most of the burden is shouldered by county clinics, federally funded health centers, health care districts and public hospitals. But the patient volumes keep growing for these safety-net providers, and they are seeing dramatic increases in patients with chronic illnesses such as heart disease and diabetes. Because of multimillion-dollar deficits each year, Stanislaus County is cutting back on health services.

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