Harbor-UCLA Medical Center and smaller free clinics and community health centers nationwide have long struggled to keep their doors open to treat patients who otherwise could not afford insurance.
Now, experts say these medical facilities may see their financial situation improve once many of their formerly uninsured patients gain coverage under the health care reform bill.
What will not happen, however, will be a tremendous shift in demand for care at Ronald Reagan UCLA Medical Center, said Gerald Kominski, a professor of public health and associate director of the UCLA Center for Health Policy Research.
“(Newly insured patients) are going to continue to seek care where they’ve been going,” Kominski said. “They’re getting good care. The clinics … actually welcome the patients now that they have insurance.”
He added that he does not foresee people getting in their cars and driving to the Ronald Reagan medical center to seek a referral; instead people will continue to go where they already have relationships with doctors and staff members.
The Ronald Reagan medical center does not see many uninsured patients in non-emergency situations.
However, half of Harbor-UCLA’s patients are uninsured and totally unfunded, said Dr. Gail Anderson, Harbor-UCLA’s medical director. The hospital only bills patients based on their ability to pay.
“Most of these patients don’t have any resources,” Anderson said. “Most of our funding is coming from Medicaid and Medi-cal.”
In 2006, Massachusetts passed a universal health coverage bill similar to the one that passed on the national level. The medical system in Massachusetts then saw a higher demand for primary care physicians, said Shana Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research.
When people who were previously uninsured get insurance, they tend to use it, Lavarreda said.
The same could happen at Harbor-UCLA.
Anderson said he hopes more insured patients will contribute to funds needed for updating equipment and providing hospital staffing. The hospital currently has a crowded emergency room and a shortage of intensive care unit beds, causing patients to wait downstairs in emergency care, he added.
The health care bill would stabilize safety-net providers like Harbor-UCLA.
“If the bill hadn’t passed, they’re going to be there, struggling to pay the bills and keep the doors open,” Kominski said. “They’re not getting wealthy, they’re not getting rich.”
While Harbor-UCLA is undergoing construction on new emergency and operating rooms, the capacity will be cramped, Anderson said.
Patients will be more interested in seeking a primary care setting without compressing the hospital’s specialty care where more complex procedures occur, Anderson said. Smaller centers in the surrounding area would provide this kind of care and refer patients to Harbor-UCLA as needed.
“As you provide more primary care, you often find more diseases,” Anderson said.
Before the bill, people would delay care, which led to increased medical costs and more advanced diseases that are harder to treat. Delayed care leads to a decreased life expectancy and quality of life, Kominski said.
The reform bill also has a provision addressing the shortage of primary care physicians and nurses needed for a larger insured population, said Dr. Dylan Roby, an assistant adjunct professor of health services and a researcher at the UCLA Center for Health Policy Research.
He added that it is difficult to encourage medical students to go into primary care, which includes family physicians and nurses, because specializing in a field like neuroscience promises a higher salary.
“There’s still less incentive for primary care doctors because they make half as much money, even though it is less training,” Roby said.
The bill would convert unused specialty care slots in residency programs across the country to primary care specialist slots, Roby said. As an example, he said an otherwise unused oncology residency position at a Texas hospital could potentially be moved to another hospital as a primary care slot.
Medicare determines how many slots will go to each specialty, which are generally stable unless a school makes a case for having more slots, he said.
When primary care slots start to increase in 2014, in accordance with the bill, it could be a contentious issue, since schools do not want to lose slots in their residency programs, Roby said. UCLA’s medical school accepts 200 residents a year and generally does not have trouble filling slots.
Parts of the bill will try and tip the scales more in favor of going into primary care.
Money from the bill could also potentially come back to UCLA to fund research in comparative effectiveness research, which seeks to reduce medical costs by finding more efficient and effective treatments, Roby said.