Doctors say charity care isn't full care

Physicians' uninsured patients often face cost and access barriers to drugs, medical tests and specialist referrals.

By Joel B. Finkelstein, amednews staff. Nov. 24, 2003.

Washington -- Most internists offer free or low-cost services to uninsured patients, but many believe that these patients still aren't getting the care they need, according to a new survey sponsored by the Commonwealth Fund.

"Even when uninsured patients do get care in the doctor's office, they are at risk of failing to get necessary follow-up tests or medications because they cannot afford them," said Commonwealth Fund President Karen Davis.

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The poll results, published in the November-December Health Affairs, show that 69% of private practice internists and 55% of those who are employees provide charity care to their uninsured patients. Just over half of those patients are established patients who have lost their jobs.

The surveyed physicians offered a median of four hours of charity care a month, not all of that in their offices. The internists surveyed also said they were less likely to accept a new uninsured patient than a new patient with private insurance.

These physicians reported a number of difficulties faced by their uninsured patients. Among the survey's findings:

Nearly half of physicians reported that their uninsured patients often failed to get follow-up tests or take medications because of the cost.
Less than a quarter of the physicians said they could consistently help uninsured patients get discounted prescription drugs or refer them to specialists for reduced-fee services.
Less than a tenth of the physicians reported being able to get reduced-fee lab tests or diagnostic procedures for their uninsured patients.
Less than half said they could provide as high quality care for their uninsured patients as they would like.
About a third said they could provide good continuity of care for these patients.

"The AMA has long held that physicians should share in the care of needy patients," said Yank D. Coble Jr., MD, immediate past president of the American Medical Association. "However, ... charity care is not the complete answer to the problem of the uninsured -- we need real health insurance reform to truly help those in need."