Since 2000, the number of uninsured Americans has swelled by 5.2 million, reaching 45 million or 15.6 percent of the population. About a fourth of them lost coverage despite their good incomes because their employers either dropped health benefits or new employers never offered them.
Rhode Island FP Tackles Access Problem for His Uninsured Patients
By Leslie Champlin
2/1/2005
Michael Fine, M.D., discusses patients' access to care during a town hall meeting at the 2004 Scientific Assembly.
Watching the trends, Michael Fine, M.D., senior managing partner of Hillside Family and Community Medicine in Pawtucket, R.I., decided to act. His solution -- the Hillside Access Alliance -- provides primary care to uninsured patients. In the two years since its inception, the alliance has worked so well that the Rhode Island AFP plans to take the concept statewide this year.
Patients who participate in Hillside Access Alliance pay a $75 enrollment fee, about $20 a month and $10 for each office visit. In return, they get preventive care, physicals, immunizations and same-date appointments when they are sick. Fine encourages patients to consider a catastrophic health insurance plan to cover serious illness or hospitalizations.
Patients who participate in Hillside Access Alliance pay a $75 enrollment fee, about $20 a month and $10 for each office visit. In return, they get preventive care, physicals, immunizations and same-date appointments when they are sick. Fine encourages patients to consider a catastrophic health insurance plan to cover serious illness or hospitalizations.
This story first appeared in the February 2005 FP Report.
The program alleviates the fear of health care costs, according to Fine. Before establishing the alliance system, his practice had used a radical sliding scale fee, which allowed established, uninsured patients to pay what they could afford, including nothing.
"We told them we would not turn them away," said Fine. Despite that, "they'd just not appear for three years because they were afraid of the cost. People assume it's going to cost $500 to walk in the door."
Fine researched the cost of primary care and discovered it runs $130 to $140 a year per person, compared with the average annual health insurance premium of $4,000.
"Primary care is quite affordable, less than the cost of a cell phone or cable television," he said.
The program has allowed uninsured patients to maintain their medical homes, and, without the cost of a managed care middleman, Hillside Family and Community Medicine is making money, said Fine.
Fine encountered only one snag in establishing the Hillside Access Alliance: If patients paid their monthly fees in advance, the practice would be considered a health insurance plan by the Rhode Island Department of Business Regulation. As such, Fine would have been required to maintain a $3 million reserve -- something not possible for his five-physician practice. His solution: Bill for participation at the end of the month for the previous 30 days. Now, the Rhode Island AFP has sought a $5,000 grant to defray the cost of writing software that would enable other family physician offices to establish programs as part of a statewide alliance based on Fine's concept, according to Jennifer Bianco, chapter executive. In addition, the chapter hopes to market the alliance program to uninsured and low-income families throughout Rhode Island. The marketing effort would urge residents to seek primary care, either from community health clinics or private family physicians.
"We told them we would not turn them away," said Fine. Despite that, "they'd just not appear for three years because they were afraid of the cost. People assume it's going to cost $500 to walk in the door."
Fine researched the cost of primary care and discovered it runs $130 to $140 a year per person, compared with the average annual health insurance premium of $4,000.
"Primary care is quite affordable, less than the cost of a cell phone or cable television," he said.
The program has allowed uninsured patients to maintain their medical homes, and, without the cost of a managed care middleman, Hillside Family and Community Medicine is making money, said Fine.
Fine encountered only one snag in establishing the Hillside Access Alliance: If patients paid their monthly fees in advance, the practice would be considered a health insurance plan by the Rhode Island Department of Business Regulation. As such, Fine would have been required to maintain a $3 million reserve -- something not possible for his five-physician practice. His solution: Bill for participation at the end of the month for the previous 30 days. Now, the Rhode Island AFP has sought a $5,000 grant to defray the cost of writing software that would enable other family physician offices to establish programs as part of a statewide alliance based on Fine's concept, according to Jennifer Bianco, chapter executive. In addition, the chapter hopes to market the alliance program to uninsured and low-income families throughout Rhode Island. The marketing effort would urge residents to seek primary care, either from community health clinics or private family physicians.
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