Private sector faces bigger role in health Print this article | Go back Monday, December 12, 2005 KENTUCKY'S HEALTH: CRITICAL CONDITION Private sector faces bigger role in health Universities also step up efforts to improve care By Laura Ungar lungar@courier-journal.com The Courier-Journal In the mountains of Appalachia, a young nurse employed by a private service provides care in a region short on doctors. In Georgetown, employees at the Toyota Motor assembly plant sweat on exercise equipment in the company's 40,000-squarefoot gym. In Madisonville, a University of Louisville medical student trains to be a country doctor. All are examples of the private and academic sectors increasingly playing an important role in improving the health of Kentuckians. And experts say such efforts can be models for others in the state. They are motivated by community responsibility, altruism and in many cases, money, as rising health care costs eat away at earnings, and the poor and uninsured continue to burden the health care system. "No one can sit on the sidelines," said Pete Gritton, vice president of administration at Toyota Motor Manufacturing of Kentucky. "We all have different pieces of the pie, so to speak, but we all have to take ownership for our piece." Such involvement is all the more crucial in Kentucky, where state government historically has taken a hands-off approach to policies that discourage bad habits and encourage good ones. That legacy of government inaction is one of several factors making Kentucky one of the unhealthiest states in the nation, ranking among the worst for adult smoking, teen tobacco use, exercise, obesity and deaths from cancer and cardiovascular disease. David Steurer, membership director for the nonprofit Wellness Councils of America, said any investment in health will pay dividends over the long term. "What is the cost of not doing anything?" he asked. A TEAM EFFORT Employers also benefit when workers are healthy The private sector can be a force, experts say, in two particular areas — improving access to health care and preventing chronic disease. Some of the most notable prevention efforts are coming out of the business world. Employers are spending money to improve their workers' health and seeing it pay off. Driving this trend are concerns about health insurance premiums, which rose more than 9 percent nationally between 2004 and 2005 after four years of double-digit increases. At the Toyota plant, which employs about 7,000 workers, the gym is the most visible example of its health-promotion efforts, with almost 200 pieces of exercise equipment, a track, a basketball court and 12 full-time fitness specialists. More than 4,000 employees and family members have joined, with a single membership costing $6 every two weeks. The company also fields teams in basketball, volleyball and other sports. It offers wellness classes on smoking cessation, diet and weight loss. A voluntary disease management program for those with such chronic conditions as diabetes will soon start, and an on-site pharmacy allows the company to save money by negotiating lower prices for medicines. The pharmacy averages 400 prescriptions a day and sells over-the-counter drugs at reduced prices. Employee Willie Gossey uses the pharmacy to pick up his wife's medications and also works out in the gym. Both help keep him and his family healthy, he said, adding, "Good health is what I'm going to have to have to work on that line." Toyota officials are now considering the possibility of offering on-site primary care. "We're waking up to the fact that we do have a role as an employer. It really has to be a team approach," Gritton said. "If I have good health, I'm a more productive employee. And the company wins because that cost is lowered." Other employers have come to the same conclusion. At UofL, workers can fill out health assessments done by an outside company, which helps reduce health risks for those who need to do so. Employees who work on lowering health risks, or who score low for health risks in the first place, get $20 a month off their health insurance. UofL also invites staff and students to join the university president on a weekly run. And there's a gym for faculty and staff, complete with free personal training. Employees Edie and Chris Wooton have both lost weight using the gym, and Chris has seen his cholesterol levels improve sharply. The University of Kentucky has taken similar steps to improve workers' health. And the UAW-Ford Community Healthcare Initiative has gone beyond the automaker's work force, creating community-wide task forces on such issues as obesity and chronic disease and starting a pilot project on workplace wellness for greater Louisville. Experts said every business could emphasize wellness. Small companies may not be able to imitate Toyota, but they can develop wellness libraries, put health tips in newsletters or start walking clubs. An investment of $100 to $150 per employee per year, Steurer said, can make a big difference in the health of the work force. "It's a matter of priorities and commitment." PREVENTION IS GOAL Health care providers, insurers seek to cut risks Insurance companies and many in the medical world also are making a greater commitment to prevention. And that's a big change in a system where, nationally, less than five cents of each health-care dollar has gone toward reducing risks. Insurance coverage for prevention has increased during the past decade, said Mohit Ghose, director of public affairs for the trade group America's Health Insurance Plans. He said insurance covers regular physicals and, increasingly, such services as smoking cessation and nutrition counseling. Hospitals across Kentucky also are stressing prevention with programs such as exercise clubs and weight-loss classes. Doctors increasingly counsel patients about healthy lifestyles and the dangers of behaviors that can lead to disease. And medical schools are teaching new doctors how to educate people about lifestyles — something many schools did little or none of in the past. Other efforts are aimed toward the young. UK HealthCare is battling childhood obesity through a program run by Dr. Joan R. Griffith, an assistant professor. The clinic teaches children how to eat sensibly and make exercise a habit — involving parents too. Michael Taylor, an overweight 14-year-old, exercised with his sisters on a recent afternoon at the clinic. He's learned to eat smaller portions, "stay away from the chocolate" and eat apples, grapes and Jell-O for snacks. "My goal is to watch the way I eat and to exercise more," he said. "High blood pressure and diabetes run in my family. I don't have them, and I don't want them either." SERVING UNDERSERVED Doctors, clinics, others improve access to care While many efforts seek to prevent disease, others try to help people get medical care. Nearly two-thirds of Kentucky's 120 counties are designated as medically underserved for primary care. Access issues are made more difficult by a shortage of doctors, clinics and hospitals. Many low-income patients also lack insurance, transportation or the ability to take time off from work for medical appointments. Thus, some are diagnosed with late-stage disease when they finally seek care — and some die early. But some doctors and hospitals are providing free care to such patients. At the Angels Community Clinic in Murray, several in the medical community have joined forces to turn individual charitable efforts into something larger. More than 50 people — including doctors, nurses, dentists and pharmacists — volunteer their time. The 5-year-old clinic, which rents its building for a dollar a year from a local hospital, serves the working, uninsured poor of Calloway County. On a recent Tuesday evening, patients began arriving early. Among them was Roxanne Eversoll of Murray, a 34-year-old cashier at a gas station. Suffering from pelvic pain and bladder problems, she recently underwent surgery and hoped to get another operation. Murray said she'd rather pay for a doctor than go to the clinic, but that she didn't have the money. Later that evening, Eversoll sat opposite Dr. Clark Harris in an examining room. "I'm at my wit's end. I'm hurting," she told him. "I'm out of options." Harris asked her about her symptoms and her medical history and gave her a referral to a women's clinic that has agreed to see Angels' patients for free. Harris said he is willing to volunteer regularly at the Angels clinic because of patients such as Eversoll. "There's definitely a need to keep people out of the emergency room," he said, "to keep them from falling between the cracks." Some experts say there is also a need for more federally qualified health clinics for low-income Kentuckians. More than half of Kentucky's poor counties lack such centers. The University of Kentucky sends specialists to rural areas in a program designed to provide specialized care where it is lacking. Dr. Jacqueline Noonan, a pediatric cardiologist, has been making the trips for decades. The effort, she said, makes it much easier for rural residents to see specialists. "There aren't any pediatric cardiologists except in Lexington and Louisville," said Noonan, a UK emeritus professor. "It's much easier for (Eastern Kentucky residents) to find their way to Prestonsburg than to Lexington." The Frontier Nursing Service also fills a gap in that doctor-poor region, bringing full-time care to Eastern Kentucky with four clinics, a hospital, a home health agency and a school that houses the nation's longest continually running nurse-midwife program. Founded by nurse-midwife Mary Breckenridge in 1925, its first midwives traveled the state's Appalachian region on horseback, assisting with births. The service's history inspired 29-year-old Angela Mitchell to take a job as a nurse practitioner at its family practice clinic in Manchester. "We provide as good care as a physician, and are cost-effective," Mitchell said. RECRUITING DOCTORS Agencies, schools help regions `grow' their own Other efforts aim to end doctor shortages permanently. Appalachian Regional Healthcare, which operates seven hospitals in Eastern Kentucky, uses the prospect of stability and a guaranteed income to lure doctors and reduce turnover in a region that has had a chronic shortage of physicians. "Employment is one way to get them," said Dr. Daniel Varga, president of the Kentucky Medical Association. "... But this is also a pipeline issue." The Kentucky Area Health Education Centers Program, a collaboration that includes the University of Louisville Health Sciences Center and the UK Medical Center, starts early by introducing kindergartners to health careers with puppet shows. The program also includes hands-on science classes for middle and high schoolers as well as a 13-week program preparing older students for the Medical College Admission Tests. The UofL School of Medicine's Trover Campus in Madisonville, a partnership with the Trover Foundation, also tries to "grow" doctors in rural areas. A four-week summer program gives high school students the chance to shadow health professionals and prepare for college entrance exams while at home. A program for older students provides scholarships and four-week summer sessions during three years of college. And a small group of UofL medical students who begin their training in Louisville spend their third and fourth years in Madisonville to increase the chances they will practice in rural towns. Crosby Rechtin, a 27-year-old from suburban Newport, said his rural-medicine training recently gave him the chance to deliver a baby and listen to tiny heartbeats during pregnancy checkups. He finds his patients and colleagues friendly and likes living in Madisonville. "I would like to practice in a rural area," Rechtin said. "I just like the quietness of small towns." Such programs can be a model for others, experts said — and can make a real difference in the health of the state. Changing the state's health won't happen easily or quickly, said Gerry Roll, executive director of Hazard Perry County Community Ministries. "But just because we can't change it tomorrow doesn't mean we shouldn't start now." Print this article | Go back