Most of the uninsured living in South L.A. don't receive health care from federally qualified community health clinics.
Instead, says Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic, most southside Angelenos access care through urgent care clinics. The signs on these places may not say "urgent care," he said – oftentimes they'll call themselves clinica familias or name themselves after a saint, but they essentially provide urgent care services.
"And they're cash clinics," he added.
Meaning you pay per service, rather than just a single co-pay, as folks with health insurance usually do. Cash clinics have a tendency to "nickel and dime" their patients, said Aguilar.
"Fifty dollars for the visit, so much more for the medicine, so much more for the X-rays," he said. That adds up – and so people start doing their own "economic analyses," deciding what they can and cannot afford. Preventive care usually gets the short end of that stick.
Patients will ask themselves, "What is the most important thing I need?" said Aguilar. "OK, my back hurts. Maybe I'll get X-rays. But I won't get labs. Or they offered me a flu shot – I'll pass on that because that costs me another 20, 30 bucks.
"That's what happens every day down here," said Aguilar.
But cash clinics don't provide what Aguilar calls "comprehensive services," with an emphasis on preventive care. Federally-qualified community centers do, and a patient's ability – or inability – to pay doesn't preclude her or him from getting taken care of.
Gauging the value of community health clinics
A new study from the California Primary Care Association looked at how Medi-Cal patients who use federally qualified health centers (FQHCs) compare to Medi-Cal patients who use other sources of care – cash clinics, for example.
Compared to patients who used different sources of health care, FQHC patients had:
- Rates of multi-day admissions that were 64 percent lower.
- About a quarter of the total inpatient bed days.
- Rates of emergency room visits that were 18 percent lower.
- Thirty-day readmission rates that were 4.9 percent lower. This refers to patients who are admitted to a hospital within 30 days of their previous visit.
"Any hospital readmissions, regardless of underlying health risk in the patient population, can be considered a lapse in quality in the overall health system," wrote the report's authors. That they're less likely to happen in a FQHC setting is a good thing.
On top of that, they're cheaper. Patients who used FQHCs had an average monthly health care cost of $414 – that's 37 percent lower than what other patients pay per month, which averages out around $656.
All of that, said the report's authors, underscore how federally qualified health centers are "demonstrating value." FQHCs, they wrote, represent "a new frontier" in improving the quality and cost-effectiveness of patient care, as well as patient health.
This wasn't the first study to highlight the effectiveness of community health clinics.