May 2, 2014
Rural populations in the United States are more likely to live without health insurance than their urban counterparts. That disparity, combined with the difficulty of bringing doctors to rural areas, has led to many programs that aim to bring health care to the countryside.
The Ovid Health Center is in a refurbished church on Main Street in the middle of the village, about half way between Ithaca and Geneva on Route 96.
An Amish man and a young girl sit in the waiting room, while another middle-aged man talks on a cell phone.
This health center is part of Finger Lakes Community Health, one of New York’s 50 or so Federally Qualified Health Centers, or FQHC’s. About 20 percent of their funding comes from the federal government, which started offering support to clinics in areas with health care shortages 50 years ago.
There is no hospital here in Seneca County. The closest one is Geneva General, 23 miles away. And, because of the wine industry, this area is growing more than most in Upstate New York.
Jim Kennedy, chief compliance officer at Finger Lakes Community Health, works out of a small, new-looking office in the basement of the Ovid Health Center. Kennedy says the region’s growing wine industry means a growing demand for clinics like this one.
“So they’re small, agricultural, basically, operations and as a result I believe many of them are not able to provide the kinds of health insurance that larger organizations can.”
Kennedy says 40% of the patients coming in to their clinics were already on Medicaid. And now that the Affordable Care Act has expanded Medicaid in New York and private insurance nationwide, rural clinics are starting to see more and more people who haven’t been to the doctor in a long, long time.
Elizabeth Ryan is the doctor at the Ovid clinic.
“What I’ve really noticed is that chronic diseases have gone untreated for years in a large proportion of my patients. So like people that weren’t aware that they had diabetes and it’s clear from testing that it’s been there for years. Or they’ve had high blood pressure, so, ‘oh yeah, someone I think mentioned that ten years ago but I never did anything about it.’”
Ryan says waiting to treat those conditions means once they get to her, all kinds of complications have developed, leading to more trips to the emergency room.
“I think there’s also a lack of basic health education, which is, in my, I guess I’m sort of assuming or guessing that that’s partly because there hasn’t been health care integrated into these communities as well as it has in urban areas.”
A major change going on in the health care industry is a struggle to reduce costs, starting by reducing trips to the hospital. According to a 2010 study by the Rand Corporation, about 17 percent of emergency room visits are unnecessary and ending those visits could save $4.4 billion a year.
Cooperstown-based Bassett Health Care has devised one way to help combat this problem: health clinics in schools.
Chris Kjolhede is the medical director for Bassett’s school-based health care program, which has 19 centers in 14 districts in Otsego, Schoharie, Chenango and Delaware Counties.
Kjohede says the centers address a key need in rural areas.
“It’s hard for single parents who are working to take time off because that means they’re losing wages to get their kids to health care.”
Kjolhede says that means the problem will just get worse, and often lead to a hospital visit. But at this clinic, in the tiny Town of Milford near Cooperstown, the Bassett nurse can just walk down the hall and pull a student from the classroom if she needs to.
The school-based program also gives nurses and Bassett, a chance to stay with a kid through high school.
“Our oldest program is about 22 years old so that there’s no kid in that school now that is currently attending that school which is in Delaware County, there’s no kid there that has not known school-based health.”
Sonja McCann is the Bassett nurse at Cooperstown Central School. She sees kids on referral from the school nurse, so the ones who used to be sent home, or whose parents are called and told they need to go to the doctor, can go down the hall and see her instead.
“We’re trying to head off kind of the major health care crisis that’s coming down the road.”
McCann’s referring to helping out kids with health education and regular checkups. But it’s a pretty good summary of rural health care in upstate New York too.