Moses Carey, Piedmont Health Systems, Orange, Chatham, Alamance and Caswell counties: "We will probably see a widening of disparities because of the direction the health care field is going. More and more people are having difficulty getting access to health care and more are uninsured because of the economy. We see a lot showing up at our center. Most community health centers in this state and other states--despite the fact that there have been some additional resources in the pipeline--are struggling to maintain the bottom line. We are being oversolicited. The hospitals say, 'We aren't sending anybody to health centers.' But institutions of the state don't have to actually say that; all they have to do is put policies in place--be more aggressive about collecting for the uninsured, or send people to collection agencies. And for a while, up until the last few years, a subtle way of sending a message was that you didn't hire any Spanish-speaking staff. It's dehumanizing if you can't pay and you can't go places. People are proud, they have feelings. Especially for some of the older patients, they just sit home and wait for the ambulance to come. Then, it's very expensive to care for them and we all pay for that."
Evelyn Schmidt, director of Lincoln Community Health Center, Durham: "Access to care is what Lincoln is all about. Seventy-four percent of the population we saw last year was totally uninsured. We saw over 35,000 different patients, of which 27 percent were Latino, 8 percent white and 60 percent were African American. Studies like this raise a lot of questions about where people are going for care. Is the difference really based on race or on other factors? Remembering that low income still plays a big role. Unfortunately, we still see a disproportionate low income among our African-American population. Low income is food, clothing and shelter. Also, the environment--sometimes being forced to live in not the best neighborhoods. All of these can aggravate chronic health problems. With health, you have to look at the total environment and how that impacts disease. Right now, our system is out of whack. We may have the best medical care for complicated diseases but we do nothing to prevent them."
Olivia Fleming, director of Urban Ministries Open Door Clinic, Raleigh: "One important disparity they named in this report was the percentage of people who during the last 12 months, didn't see a doctor when they needed to [a majority were African American and Latino]. That points out access to primary care, which is a real issue. There are a number of things that are affected by people taking an active role in their own health care. Health literacy, which means having culturally sensitive programs to deal with various races and ethnicities, is important. Our medical care system today is very much the managed care model. But with people with low health literacy who have many problems, you really can't deal with those in just 15 minutes. I don't feel we are a dumping ground. I almost resent that thought.
Physicians who volunteer here have generally worked at least 40 hours already and they come here and give freely of their time because they are concerned. All the hospitals support us. The problem is a systemic one. We've looked at government to solve these problems. It would take a different message being sent to government. Instead of being concerned about not paying any more taxes, we would be recognizing that there is a problem that will require more money. The population in our area is increasing but we haven't been allocating the resources to deal with it. I know some studies have documented unequal [health] treatment. I have not seen that in our community. The differences that are there are because of lack of coverage and the limits on what providers can do."