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Op-Ed Fri Apr 06 2012
According to an article posted Tuesday by Crain's, Chicago was ranked 215th out of 306 health care markets by a report from the Commonwealth Fund. According to the article, it was ranked so low due to "high costs, high rates of uninsured, very high rates of potentially preventable hospital admissions and low rates of preventative care such as screening for breast and colon cancer."
For context, Boston, Philadelphia, Manhattan, Atlanta, Detroit and the Bronx ranked higher at 41, 101, 127, 166, 189 and 206 respectively. Among the cities that ranked lower were Los Angeles, Miami, Dallas and Memphis.
A possible problem Chicago has is that in some areas it has too many hospitals and in others not enough. For example, in Uptown, where I live, there are two hospitals that I could easily walk to: Thorek Memorial Hospital and Weiss Memorial Hospital. Additionally, Advocate Illinois Masonic Medical Center and Swedish Covenant Hospital are not that far of a trip. The North Side also has two hospitals with Level One trauma centers, while the West Side has one and the South Side has none. The geography of Chicago's hospitals suggests that if you need a hospital, the closer to the Loop you are, the better. Unless you live on the North Side.
But hospitals cannot be the only way to treat people. Primary physicians and clinics are important as that can help with preventative medicine, which could in turn reduce the number of ER visits. Unfortunately, doctors throughout Chicago vary in quality and appointments for specialists have to be made months in advance.
Ultimately, Chicago's health care problem is rooted in its hyper-segregation. Primary physicians are not that easy to find outside of the downtown area of Chicago, unless you live on the North Side. Chicago is lacking in urgent care clinics, which serve as great alternatives to emergency rooms. Additionally, most urgent care clinics charge what a physician would charge rather than an emergency room, which saves a patient money as well as the health care provider.
Furthermore, Chicago has a problem with charity care. In order for a hospital to keep its non-profit status, it must provide a certain percentage of charity care to patients. This means that if someone is treated in the hospital and they will have a hard time paying or cannot pay, the hospital has to help them out. Last year, Northwestern's Prentice Women's Hospital lost its non-profit status as a result of not providing enough charity care.
As a result of this, someone might think that this requires hospitals to treat everyone who walks through the door. That would be the Emergency Medical Treatment and Labor Act that was passed in 1986, making "patient dumping" illegal. This doesn't mean that patient dumping doesn't happen. In fact patient dumping allegations were leveled at University of Chicago Medical Center in 2009 after a boy who had been mauled by a pit bull was allegedly sent to Stroger Hospital for treatment.
The program at University of Chicago responsible for that is called the Urban Health Initiative, which is supposed to send people to a primary physician if they come into the ER with a minor problem.
This is a well-intentioned program since some things like a cold or the flu can be checked out by a doctor. However, there are questions that are raised by this program. Are patients followed up with to see if they are actually seeing a physician? And how many of these patients actually have minor ailments that should be seen by a physician?
The most depressing thing about Chicago's health care is that the best solution anyone can come up with might be the cause of patient dumping.
There is no easy way to fix Chicago's health care problem because it would require for solutions like more quality community clinics with low or no cost or urgent care clinics to be invested in. But Chicago may not be a city to attract people to invest in more health care since at least four hospitals in Chicago closed in the past decade.
Chicago's health care situation is not new and the city has been struggling with improving preventative measures for the poor and uninsured. In the book County: Life, Death and Politics at Chicago's Public Hospital, Dr. David Ansell tells about the creation of the Breast Cancer Screening Program at Cook County Hospital while he was there and says this at the end of a chapter:
In 2006, my colleagues and I discovered that, despite efforts like the Breast Cancer Screening Program, black breast cancer mortality had not budged in Chicago since the early 1980s and the Chicago racial gap in breast cancer mortality was the largest in the U.S. Why? We postulated that the health-care system in Chicago was designed in such a perverse way that black women were still unable to receive the best outcomes despite all advances in breast cancer care. As a result, hundreds of black women died from breast cancer each year in Chicago because they did not have the same outcomes as white women.
Can Chicago really improve its health care? Considering that in some ways the system has worsened by losing clinics and hospitals, it seems like that might take a lot of hard work.