COLUMBIA — For Debra Howenstine, the lack of diagnostic care for uninsured patients is nothing new.
“I could tell you story after story about people who haven’t been able to get health care,” said Howenstine, medical director of the Columbia/Boone County Department of Public Health and Human Services.
One of her patients had a large pelvic mass that was continuing to grow. The patient needed to get an ultrasound to determine whether the growth was benign or malignant but couldn't afford the $300 procedure.
For many of the estimated 18,000 residents of Boone County without health insurance, crucial diagnostic screenings and preventative care are out of reach.
An X-ray can cost up to hundreds of dollars and a colonoscopy runs at about $3,000 for someone without insurance compared to $25 or $50 for those with insurance.
The cost of such procedures, Howenstine said, often makes diagnostic tests “beyond the realm of possibility” for uninsured patients. “We constantly have patients that need diagnostic studies,” she said.
Howenstine said there is a system in place to provide diagnostic studies for the uninsured, but cost remains a barrier.
Through the system, uninsured patients can get a discounted rate on diagnostic procedures. However, these discounts still do not offset the cost.
Even with discount prices, Howenstine said these procedures are “still very often out of reach of patients.”
And in many cases diagnostic services and necessary follow-up treatment are crucial to saving lives, said Kim Bailey, senior health policy analyst for FamiliesUSA, a nonprofit health care advocacy organization.
According to a study by the organization, there were an estimated 23,400 deaths of 25- to 64-year-olds because of a lack of health care coverage in 2009 alone. Since 1995 the number of Americans that have died prematurely because of they lack medical insurance coverage totals more than 294,000.
In Missouri the organization estimates that around 5,000 people have died because of a lack of coverage since 1995.
“What really happens is that people who don’t have health insurance don’t get care at the time that they really need it,” Bailey said.
The uninsured have a 25 percent higher risk of premature death than those who have health insurance, Bailey said.
Clinics like MedZou and the Family Health Center are able to provide free or low cost outpatient services for uninsured patients but are unable to provide diagnostic services such as colonoscopies, cardiac stress tests or imaging studies, which are often critical in devising a strategic treatment plan.
John Morrison, the financial director for MedZou, said there is a tremendous need for diagnostic services for MedZou patients.
A need so critical that the clinic entered a contest through the Pepsi Refresh Project to win a $50,000 grant to spend solely on diagnostic tests.
The group with the most online votes wins the grant. Voting for the contest began Monday and ends on Nov. 30. To vote, go Pepsi Refresh Project and search for MedZou.
“We have patients at MedZou that we’re pretty sure have a chronic condition or disease that we can’t afford the diagnostic test for,” he said. “Through this grant we’re going to use all $50,000 to buy as many diagnostic services as we possibly can to treat these high risk patients because we don’t know, but we suspect that they have something pretty wrong with them.”
Morrison also said diagnostic services are key to treating these at-risk patients.
He said: “The problem with these types of illnesses is that they’re really insidious. You don’t really know you have it until you get to the point where you have to go to the ER. When you start having problems, it’s usually too late."
When patients can't afford diagnostics, we “try to put our heads together and see what we can do,” said Alicia Ludden, community outreach director for the clinic.
Gloria Crull, executive director of the Family Health Center, said that working with underserved patients puts an extra strain on doctors, who oftentimes have to devise alternative methods of treating these patients.
“With low income patients, you’re dealing with a whole different ball game," she said. "You have to be pretty inventive as a physician."
For example, Howenstine said that once she was treating a patient with chronic diabetes who could not afford a blood sugar meter. So in order to treat the patient, Howenstine had to come up with a different, nontraditional way to help the patient manage her diabetes.
“When you’re working with uninsured patients, there’s not just one system that works,” she said. "As a provider, you end up developing systems to manage care that you wouldn't use otherwise."
MedZou was initially created in 2008 to serve uninsured patients who were on the waiting list to be seen at the Family Health Center. At that time the waiting list for uninsured patients was six months, Howenstine said.
The MedZou clinic serves the most underserved of the uninsured in Columbia — most of MedZou’s patients have been referred by the federally qualified Family Health Center because they cannot afford to pay the minimum $20 co-pay required for a visit.
The clinic at 800 N. Providence Road in the Community Resource Center, which is open only from 5 to 9 p.m. Thursdays, has seen more than 400 individual patients since 2008.
Under federal health-care reform, which will be fully implemented in 2014, an estimated 32 million Americans will be able to purchase health insurance. Even after the new legislation is enacted, there will still be an estimated 23 million Americans without health insurance.
Bailey said that despite this, the new act is "a huge step forward and a vitally important step forward."
One of the biggest improvements, she said, is that newly insured people will have coverage and won't have to pay for co-pays for preventative screenings, which will allow more people access to care.
"For a family that's on a fixed income, even paying a $10 co-pay can be a huge barrier," she said.