too much health care in Detroit?

Detroit is a city where major landmarks are often its hospitals. The Henry Ford Health System (HFHS) operates three hospitals within the city limits and the Detroit Medical Center (DMC), recently bought by the private Vanguard Group, operates nine different health complexes. The St. John’s Providence group also runs two hospitals in the city. However, Detroit’s hospitals are just one side of health capacity in Detroit. The Detroit Wayne County Health Authority (DWCHA) lists thirty-six community health centers across the city, twenty of which are free or have a minimal fee to see a doctor. Not to be overlooked, Wayne State University’s (WSU) School of Medicine works with both HFHS and DMC as well as runs a number of health outreach programs for HIV, Diabetes, Asthma, Childhood Obesity, etc. to manage care for chronic conditions.

With such a wide array of health facilities and such a strong focus on health care it seems as though the population of Detroit should be one of the healthiest. Unfortunately, the socio-economic barriers faced by Detroit’s population leave it with the lowest numbers of individual with health insurance in the state, high rates of non-communicable/ chronic diseases, as well as a growing obesity crisis. From 2009 to 2010, in Detroit: median income dropped, numbers of insured decreased, and the numbers of those living below the poverty line increased. Likewise, the Michigan Department of Community Health (MDCH) doesn’t list all of Wayne County as a Medically Underserved Area/ Population (MUA/P), but much of the Detroit area has been given an MUA/P designation. So many health facilities, so little health care for the population.

American Public Media’s (APM) Marketplace and NPR’s Changing Gears ask if its health care overkill. With another new hospital proposed in Oakland County (next to Wayne County), politicians are hoping to bring in more jobs and revenue in the only sector that hasn’t been hit by the economic recession. “[…] there are already six existing hospitals within a 30-minute drive time that average occupancy is 55 percent. So it isn’t a hospital that’s needed by the community, it’s a hospital needed by one health system to capture market share from its competitors.” says Dennis McCafferty who represents a coalition of Michigan businesses and labor unions. Is it about the market or is it about access to care?

“Since about 1997, we’ve lost about 60 percent of our primary care physician capacity [in Detroit].” – Dr. Herbert Smitherman

As a result of the loss of primary care options, the cost of care is significantly increased for the uninsured. Over the past five years, Dr. Smitherman and the Health Centers Detroit Foundation, tracked 33,000 uninsured patients in Wayne County and moved 55% of them out of emergency rooms and into coordinated care through the Voices of Detroit program, which gave access to a primary care physician at reduced cost. The majority of patients are low income and uninsured, usually on medicaid. Dr. Smitherman says, “It is a very difficult population because often, when we want to adjust things and I want to prescribe a medication, they’re uninsured. People are literally having strokes and heart attacks because they can’t get access to a very simple medication. It is 50 times more costly to deal with that. It’s very frustrating as a practitioner that we don’t have the basic access to insurance products, etc. for people to cover their basic needs.”

With the Obama Administration’s health care overhaul Dr. Smitherman notes there will be added benefits for the uninsured.

About 56 percent of all those who are uninsured are people of color. Obviously, Detroit is 89 percent African American. – Dr. Smitherman

He notes that the many people who seek care in the most expensive environments: emergency rooms and hospitals, will have the opportunity to find a primary care physician instead of paying “10 to 20 times the cost” in the emergency room.

New options for the poor and uninsured are popping up across Detroit from the field of telemedicine. One such program is a partnership between CVS/Pharmacy and HFHS. CVS’s MinuteClinic’s, open 7 days a week and staffed by nurse practitioners and physician assistants, will have the added benefit of having the Henry Ford Physician Network doctors on-call. Henry Ford doctors won’t actually see patients in the clinics, but will consult with MinuteClinic staff as needed and will work with them each month to review patient charts. Patients who are visit a MinuteClinic and don’t have a primary care doctor will be given a list to help them find one. RiteAid is also launching NowClinic, which gives people a free call with a nurse or the option to pay $45 to talk with a doctor.

Governor Rick Snyder has called for better health and wellness across the state. Snyder’s proposal highlights the economic connections to a healthy population. He notes that everyone has a part to play whether business, nonprofit, or government.

Health is the foundation for Michigan’s economic transformation—it allows our children to thrive and learn, it readies our graduates for meaningful careers, and it permits our current workforce to grow and adapt to a dynamic economy. In this message, we lay the groundwork for a healthier Michigan, a Michigan in which residents of all ages prosper and contribute.

He has been innovative in hoping to create a database of children’s BMI’s to track the rise of childhood obesity and has called on the Michigan legislature to take action on a Michigan health insurance marketplace, where all can be insured to receive the proper health care. This seems to be the one area where Snyder isn’t cutting benefits for the poor or making it harder for them to access services.

To conclude, the health care landscape is rapidly changing across the State of Michigan and across the world. Many people are developing solutions to solve our lack of capacity in the health system through innovative programs and technologies. Politicians are on board, private companies are creating ideas, and nonprofit groups are making important connections for people without the right resources. What will be critical moving forward is to focus on patient needs as opposed to simple outcomes. People need solutions that they can control and maintain for themselves and their families. The future of health care must be collaborative.

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1 Comment

  1. Hey Alex,

    Thanks for bringing attention to this issue. Dr. Smitherman is a truly impressive guy (as is his wife); they provide in an environment that is nothing short of financially hostile. As someone who is currently being trained to be a doctor in Detroit, I am always amazed that despite the difficulty of practicing here, there are a wealth of truly impressive physicians.

    However, if we are concerned about the primary care shortage, one need look no further than the choices that young docs are making–specifically, their choice of residency.

    It’s a tough call, and I can use my own situation as an example. I love, love, love primary care. I love continuity, relationships, dialogue I also love birth and pregnancy and gynecology. Now, I could do all of these things with both Family medicine and OB/GYN, so what’s a woman to do? When I graduate medical school, I will be staring down $250,000+ in debt. If I am going to be the breadwinner (most likely) and pay off my debt to the turn of $5000/month +, what is the smarter choice? $100,000/year for family or $250,000/year for ob/gyn? It’s terrible, but I hear a lot of my fellow students having the same conversations. I am willing to live and work in an under-served community, but believe, I do not want to have gone through all this (insane crazy hard) amount of work to live paycheck to paycheck.

    😦

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