Healthy alternative

"Healthy alternative" Continued...

Issue: "MS-13: Criminals next door," June 18, 2005

The Ecks in 2003 began offering low-cost medical care to uninsured people who heard about them from their friends, their employers, and even some government agencies. For 10 hours a week Zarephath Health Center (ZHC), 46 miles southwest of New York City, is now open for business, operating with an overhead of $500 a month that covers utilities, phone, and one paid staffer who officially works only during the clinic's office hours. Everyone else, including the Drs. Eck and nurses, volunteers. Patient fees of $20 a visit, for those who can afford it, cover the overhead.

It's clear from the minute a patient enters the clinic that this isn't a government facility, or even a government-funded one. Calligraphied in large letters on one wall is Matthew 11:28-30, which begins: "Come to me, all who are weary and burdened, and I will give you rest."

A new patient's first stop is the intake room to fill out a standard health history and talk to a clinic volunteer about his basic living situation and about whom he can depend on for help. One basic principle at the clinic is: "Look for the people closest to the individual to meet needs-first the family, then the church community, and finally local and state government."

New patients also fill out an income statement where they certify that they have truthfully revealed their income and expenses. Right above the signature line is this statement: "I recognize that other people are donating their time and money so that I can receive care at a reduced rate. I am thankful for this help. People are doing this because they care. I waive my right to sue, but am willing to submit to arbitration to cover future medical expenses if a mishap occurs while I am being treated here." Right away, before any services are rendered, the clinic signals to patients that they are leaving the world of lawsuit-crazy medicine and entering a new world of neighbor helping neighbor.

Since many clinic patients have chronic and untreated illnesses, they are, in general, sicker than the patients the Ecks see at their regular office. On one Wednesday night they saw Ingrid Dahl, a healthy graduate student in gender studies at Rutgers, who needed a physical and couldn't get into a university health clinic. But more often they see patients like Mary, whose job doesn't include insurance.

Mary first came to the clinic because of severe headaches, and an exam revealed that her blood sugar level had soared to 400 (normal is somewhere between 83 and 110). The Ecks provided her insulin and have monitored her sugar levels regularly, as they were doing that Wednesday evening. Before leaving the office, Mary talked with Susanna, the office manager who is also diabetic, and they exchanged tips about managing their disease.

Another patient that Wednesday night was Amal Gurguis, who first came to ZHC with a chronic untreated thyroid condition, high blood pressure, and emotional problems brought on by her husband's death. She could not afford the lab tests required to monitor her chronic conditions. The Ecks had given her a physical and lab tests, and had stabilized her medicines; now they were dealing with her allergies.

When patients with chronic needs can't afford medication, pharmaceutical companies step in to fill the gap. Using special programs designed for the uninsured, the Ecks are able to write prescriptions that the companies fill directly, sending the meds to ZHC in the patient's name. Pharmaceutical representatives who service the Ecks' fee-paying practice have been generous with samples intended for clinic patients. These programs enable the Ecks to care for patients who need medicines like insulin and can't afford the $300-a-month cost.

The Ecks act as advocates for patients who need surgery, negotiating lower rates with specialists and hospitals. Under the present system hospitals charge uninsured patients much higher rates than insured ones, who benefit from the negotiating power of HMOs and other insurance companies. One example: An uninsured patient's hospital bill for a hernia surgery was $8,700, but the Ecks know that the hospital would charge Blue Cross/Blue Shield only $2,100 for the same care, so the Ecks pushed successfully to get the lower rate for their patient. Hospitals deal with the Ecks because they usually would rather collect something than wait months for government reimbursement, or write off the amount as an uncollectible debt.

The Ecks encourage all patients to pay the clinic something; those with little money often donate their time. The Ecks want ZHC to be a model for a system where "people budget and pay for their own health care, but when they are in trouble, they get subsidized by friends, family, and the church." The Ecks point to first-century Christian communities, and a more recent precedent comes from mutual aid and fraternal organizations that provided health care for millions of Americans a century ago.


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