Lack of low-cost health care in Columbia leaves some without coverage

COLUMBIA — A city with six hospitals and scores of private practitioners, Columbia appears to have plenty of health care options for its residents. Yet, because only one organization in the area offers low-cost general health services, many uninsured citizens have no health care.

Of the approximately 146,000 residents living in Boone County, 12 percent do not have health insurance, according to the 2008 Boone County Community Assessment. The Family Health Center served slightly more than 11,000 patients in 2007, which leaves a gap of approximately 6,500 uninsured residents.

Aside from the center, people looking for low-cost medical care can find some help at the Columbia/Boone County Health Department, which offers limited services like immunizations, reproductive health care and help with paying for medications. The center, however, is the only organization offering comprehensive health care.

The idea for the health center, which was established in 1992, developed when Coleen Kivlahan, a physician with University Hospital, and Linda Hancik, a nurse practitioner for the county health department, joined to help start a clinic that would provide more appropriate services for outpatients.

“They needed someone who would provide services on a sliding discount dependent on income,” said Gloria Crull, the center’s executive director.

Crull said Kivlahan went to the three major hospitals at that time – Columbia Regional Hospital, Boone Hospital Center and the University Medical Center, now known as University of Missouri Health Care – and asked if each would be willing to sign a five-year contract that allocated the funds to start the clinic. The hospitals benefitted from the clinic because it helps cut the number of people who might use the emergency room for general health care purposes.

Once the hospitals agreed, the clinic rented a 2,000 square foot space next to the state Division of Family Services, which decides if a person is eligible for Medicaid. The family services division helped the clinic get its first customers.

“They would send them across the hall to the Family Health Center,” said Crull, who recalled the ease of finding patients. From that point, word quickly spread about the clinic.

The clinic has moved three times, finally finding its current location on Worley Street in 2004. The health center also added several other locations, including the Blind Boone center in 1994, the dental center in early 2002, and the Salisbury location in spring 2005. Blind Boone, at 301 N. Providence, and Salisbury, at 307 S. Broadway in Salisbury, offer services similar to those at the Worley location. They provide immunizations and pediatric care, but the main branch also provides mental health care. The Family Dental Center, at 601 Business Loop 70 West, has two dentists and one dental hygienist who provide comprehensive dental care similar to services found in a private office.

Like the health center, the Columbia/Boone County Health Department serves anyone who comes seeking medical assistance, whether or not the person is able to pay for the services.

“Here, we won’t turn anybody away,” said Deidre Wood, public information specialist for the Columbia/Boone County Health Department.

Although the health department offers some services, it does not provide the same general family health care the Family Health Center provides. Aside from the emergency departments at hospitals, the center is the only place people can turn if they do not have a primary care physician. However, there is a four-month waiting list for new patients.

The center is able to afford only three full-time doctors, who each works 40 hours every week, along with other part-time staff members. Although the Family Health Center offers a competitive salary and benefit package, Crull understands why there are not more doctors running to the center to offer their services.

“You really have to have a passion for the mission of the organization,” she said. “This work isn’t for everybody.”

With three physicians, the number of patients the center can accept is limited.

“When you establish care with a physician, on average a patient sees that physician 3.5 times per year,” Crull said. “And we need to make certain we have enough openings in the schedule to accommodate follow-up visits.”

While patients are on the waiting list, they are forced to look for other options for health care, which generally means the hospital emergency room. Despite the long waiting list, the health center laid off some of its physicians and support staff in January 2003 because it lost a major funder.

University Hospital was facing budget problems of its own and chose to stop funding the center, Crull said. Because the center is a federally qualified health center, the government sent a consultant to restructure the staff and organization after the cut, in hopes that it would be able to stay open.

The Family Health Center receives nearly $1 million in grant money from the government, 21 percent of organization’s budget. In this fiscal year, the budget is $5.2 million. The center also receives 20 percent from other state and local organizations, such as the Columbia Area United Way, Boone Hospital Center and University Health Care. At 59 percent, the majority of the center’s operating budget comes from payments from patients, Medicaid, Medicare and insurance companies, among other resources.

Although the city health department shares its building with the center, it does not help financially.

“We’re in the same building, but we’re separate,” Wood explained.

One misconception is that the health department offers general medical care like the center does.

“I think there’s a need for better understanding in the community about what public health is," Wood said. "If you come in and you’ve had the stomach flu, you would not go to the health department. We don’t provide the same services as your personal family health care provider.”

Like the health department, the center is unable to provide free services, mainly because it receives money from the federal government. Crull said patients are required to provide documentation of income and proof of the number of persons in the household. The center charges on a sliding scale.

When Medicaid was changed in 2005, many of the center’s patients, along with those in the community with private primary health care, lost their Medicaid insurance, which strained the center’s budget. The people in the community who were no longer insured were referred to the center, which created a demand for medical care the Family Health Center has had trouble satisfying.