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Many more public hospitals probably will end the year in the red, said Larry Gage, president of the National Association of Public Hospitals and Health Systems. "For some, the situation is even more dire, with projected losses potentially reaching tens of millions of dollars next year," he added.
Federally funded community health centers, first created in the 1960s, have long been a mainstay of the safety net. Annual funding almost doubled in the last decade, to about $2 billion. In many towns, hospitals and health departments have abdicated patients to these clinics.
"We've held our own for the past several years," said Craig Kennedy, an official with the National Association of Community Health Centers. "But we're facing the worst difficulties we've seen in quite some time."
Health departments are another piece of the safety net. Most aim at disease prevention, like vaccine clinics, restaurant inspections and tuberculosis-monitoring to make sure patients take their medicine. About 10 percent offer full-service clinics, partly because that brings in some income, whether it's cash or Medicaid reimbursement.
But many are looking at cutting services, or restricting what they pay for.
Northern California's Santa Cruz Health Department likely will cut as many as 30 of its 150 jobs this year. The department -- which manages state and local funds for indigent care -- also stopped paying for such things as joint replacements and cataract surgery.
"They're all wrenching decisions," said Dr. Poki Namkung, the department's director. "It's not the level of services people would expect to have in a civilized country."
Last year, health departments cut 11,000 jobs and this year expect to shed another 10,000, according to a report this week by Trust for America's Health, a research group.
Some health departments have been getting out of the patient care business. In Georgia, the suburban DeKalb County Board of Health treated patients for a dozen years at two clinics. That ended in September, in part because the state's Medicaid HMO system quit paying for care at health departments.
The department is now referring its previous patients to nearby community health centers. That's how Kordie Green ended up at Jeffrey Taylor's Stone Mountain clinic one morning this week.
It's hard to find a doctor, especially an attentive one, when you don't have good health coverage, said Green, 52, an uninsured child care worker who needs a continuing prescription for a thyroid condition.
"You want someone to take the time to see you and take the time to explain what's going on with you," she said.
On the Net:
National Association of Community Health Centers: http://www.nachc.com/
American Public Health Association: http://www.apha.org/
Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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