How to Obtain Health Care Without Insurance

For the 50 million people without insurance in the United States, this blog is for you. How do you obtain health care if you have no insurance? There are four basic methods for accessing care sans health insurance financing and they are; pay with cash or credit per clinical visit, frequent public health centers in urban areas, access community health centers in rural and metropolitan areas, and use the old standby, hospital emergency departments. The average person who is without insurance may feel there are no options other than paying out of pocket for treatment and worse yet, frequenting the emergency room for care. The lack of health insurance does limit the number of clinicians who will serve the patient, but there are two institutional remedies in America, the public health system and federally qualified health clinics. Both of these organizations are designed to provide primary health care on an as-needed basis for under-served populations, including the uninsured.

CHC-Community Health Center
Community Health Centers were authorized in 1975 to promote health care for medically under-served populations. There are 3,709 federally qualified health care centers in the United States and 89 are in Washington State. One of the most famous federally qualified health centers is the Pike Market Clinic. Other well-known FQHCs in the Puget Sound area are Puget Sound Neighborhood Health Centers and SeaMar Clinics. These clinics must periodically reapply for federal funding to support the health care they provide to rural and poor urban communities. The centers also have to conform to certain governance standards, including community representation on the board, and auditing for government grant compliance. Not all "community health centers" are federally qualified health centers. The federal agency Health Resources Services Administration (HRSA) rate community health centers number one for outcome driven results, which means good value for their patients. The Bush Administration has continued to support CHC’s and increased relative funding for them. Patients must have a primary care provider in a community health clinic in order to have continuity of care. Patients will be expected to contribute to the cost of their care based on their level of household income. Also, the community clinic typically has an on-site pharmacy, so the patient can get his or her prescription filled there as well. All Community Health Clinics with pharmacies offer discounted pharmaceutical pricing, because of a federal provision called 340B Drug Pricing.

PHD-Public Health Department
Public Health Departments are most robust in larger cities, like Seattle, WA or Portland, OR but smaller communities, like Bremerton, WA have public health programs as well. In smaller communities the health department may be more involved in disease surveillance and health inspection of public facilities. However, even in smaller cities the health department is involved in emergency planning, executing public health directives like childhood immunizations, and disease investigation( like E Coli). In urban areas residents can go to the public health clinic for primary care, just like they would go to their family doctor, but payment for services is based on a sliding fee scale according to the patient’s income. Lab work is often done on the premises to save money for the health department. Both community health clinics and health departments also accept insurance for reimbursement. You might wonder why someone would choose to go to a public health department if they have insurance and the answer is convenience and also continuity. For example, if a patient has immunization records at the health department, it may be easier to continue to maintain those in one location.

DSH-Disproportionate Share Hospital
The urban poor do frequent the emergency departments of urban hospitals in droves, which is costly for the community and the facility. Consequently the federal government created a program called disproportionate share funding for hospitals that are designated as serving this population. This is a federal subsidy for hospitals so they can continue to provide care for patients who can’t pay and have no where else to go. There are 1,291 disproportionate share hospitals in the United States and 12 of those are deemed critical access hospitals in Washington State, according to the Health and Human Services administrative agency HRSA. The DSH facility in Seattle is Harborview Medical Center.

340B-Discounted Prescription Drug Program
Qualifying health care facilities are eligible for 340B drug discounts based on the 1992 Veterans Health Care Act. So, you can go to a community health clinic or the public health department or in a true emergency situation, the DSH hospital, for treatment. To obtain discounted prescription drug costs go to a community health clinic with its own pharmacy or to a DSH hospital. You do not have to be admitted to the hospital to have your script filled in the hospital pharmacy. Your script should be 25% to 40% less expensive at these facilities, than at your local pharmacy.

Take Charge of Your Health
The next time you need health care and are without insurance, consider the community clinic and public health alternatives to the emergency department of a hospital. The hospital ED is expensive, will require a lengthy wait (several hours), and misplaces resources for primary care, which are geared to urgent care. According to the Washington State Hospital Association hospitals in the state incurred 217 million dollars in costs for charity care in 2005. Remember there are health care alternatives to the emergency department, right in your neighborhood, accessible to all, and reimbursement is based on your income. Be smart about your health, its better for everybody.


This article was written by Roberta E. Winter, MHA, MPA and may be reprinted with her permission.