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Access to Care Limited, Health Experts Tell Senators

Feb. 1, 2008 — With medical costs and the number of uninsured on the rise, providing residents with access to health-care services is becoming more difficult, a panel of medical experts told senators during Friday's meeting of the Committee on Health, Hospitals and Human Services.
Adding to the challenges is a lack of funding, testifiers said. Since the territory's two hospitals were transitioned into semi-autonomous government agencies, a large amount of the facilities' financial resources have come from the federal government. However, a number of economic challenges over the years — including high fuel costs and a looming national recession — have been drying up the money pool, requiring more assistance from the local government.
"As we have seen the shrinking of the funds in our local budget, we have also been witnessing uncollectables in the past few years that are approaching $30 million," said Dr. Olaf Hendricks, medical director at Juan F. Luis Hospital (JFL) on St. Croix. "It's no secret that Juan Luis is behind on its bills to WAPA — but we would be able to pay if we had the good fortune of being able to select the people we provide care to. But as it is now, we can't turn anybody away."
JLF's plight was made more evident on Thursday, as the V.I. Water and Power Authority's governing board denied a request to power a large transformer on the hospital's property. No new service contracts with the hospital will be executed until JFL honors a 2003 agreement to pay more than $4 million in outstanding electric bills dating as far back as eight years ago, WAPA board members said. (See "WAPA Nixes Hospital's Temporary Power Contract.")
But the hospital's failure to drum up cash has had other detrimental effects, Hendricks added. With the inability to turn away patients comes a lack of resources, such as beds for patients, along with an increase in medical errors, which has caused more than 200 deaths per year across the United States, he said.
"As we struggle more and more with the meager resources we have, continue to respond to regulatory demands and fiscal compromises, there has to be a crack someplace," Hendricks said.
Despite attempts to hire specialists and build the hospital's programs and facilities, more and more patients are coming in with chronic diseases, requiring the type of care that their families, and the hospital, are unable to give them.
"Anyone that presents themselves to a hospital, we provide them with the services that they need to the best of our ability," he said. "When we can't take them any further — like if their insurance runs out, or they just don't have any — we make attempts to get them to a proper facility. But the reality is that in some cases, we have to make a judgment call. Even with people who have insurance, sometimes their bills total up to $400,000 and the co-pay on that is $80,000. How many of us can cover that? So we are forced to make a difficult choice."
According to local statistics compiled in 2004, 29 percent of adults throughout the territory had no form of health insurance. Data from the Bureau of Economic Research show that 50 percent of all V.I. residents do not have health insurance — compared to 17 percent nationwide.
The growing number of uninsured isn't the only factor contributing to the financial burdens borne by hospitals and clinics throughout the territory, however. Fear of a national recession, coupled with the limited amount of Medicare and other federal funds trickling into the territory, are also contributing to the gap in health-care services, and the inability of certain agencies — such as the V.I. State Insurance Program — to provide residents' with much-needed assistance.
"Currently, over 96 percent of our funding comes from the federal government, and instead of going toward the programs, over 95 percent of it goes to staff," said Jason Henry, territorial HIV-prevention coordinator for the Department of Health. "So where are the funds for additional health kits? Where are the funds for the condoms we need to distribute to the community?"
While the department is working on a number of outreach initiatives geared toward uncovering the large number of HIV/AIDS cases in the territory Henry said, there is still a need for money to hire workers to go out into the community and provide testing and counseling services for patients unwilling to show up at local clinics. As a result, only a little more than 800 HIV/AIDS cases have been reported, he said.
"We need to think about how we are going to reach the all the people out there," Henry said. "We just have enough funding to staff our clinics — what about the others, what about the homeless? We also need to provide training for our employees. So, senators, we definitely need your assistance."
Henry's remarks were echoed by Department of Health Commissioner Vivian Ebbesen-Fludd. The implementation of mobile clinics providing on-the-spot HIV testing and treatment are becoming a more effective, and popular, way of reaching out to patients, she said.
"HIV treatment is increasingly effective, both in saving lives and in limiting the spread, but grant funds for treatment and diagnosis are no longer available in the amounts we've previously received, and now need to be replaced by local funds," she said.
While senators said they would look at addressing many of the concerns brought up during Friday's meeting, Henry also discussed the need for community members to be more involved in prevention efforts.
"Throughout the community, we are afraid to discuss these issues, because speaking about HIV means speaking about sex," he said. "With that kind of stigma attached to the disease, how do we get into places like schools and churches to talk about prevention? So we're trying now to find more creative ways for us to get out there, but we need your help with that also. It's time for us to change our mindset — prevention is one of the most effective ways for us to solve this problem and stop the spread of HIV."
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