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Project access

11/07/05 12:00AM By John McClaughry
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(HOST) As the debate about the future of health care in Vermont continues, commentator John McClaughry suggests a model that he thinks could be successful here.

(MCCLAUGHRY) Here's a "good news" story about health care, from western North Carolina.

In 1995 the Buncombe County Medical Society marshaled the resources of state and local government, foundations, pharma- cists, hospitals, nurses, dentists, educators, community clinics, churches, and social service workers to create Project Access.

After six years of operation, 17,000 out of 19,000 uninsured low and moderate income people had joined the program. Each of them signed personal responsibility agreements for keeping appointments, taking medications as prescribed, and complying with treatment plans. Eighty-five percent of the county's physi- cians are committed to the program. They agree to see ten pa- tients a year for primary care, and twenty per year for specialist care, or volunteer eight sessions at a free clinic. Hospitals donate inpatient and outpatient services and lab tests. Pharmacists pro- vide prescription drugs at cost; the patient pays a four dollar co-pay, and local government subsidizes the difference.

Since 1996 the providers have given thirty million dollars in docu- mented care. Because of the ready access, eligible people are showing up earlier for preventive care. Emergency room visits by the lower income population are less than one third that of similar populations in similar cities. Reduction in avoidable repeat visits has allowed the clinics to increase by fifty percent the number of primary care patients they see.

Businesses report that absenteeism is down and productivity is
up among low-wage workers. Interestingly, more than half of the participants become insured after six months, suggesting that their better health and attitudes make them more likely to find
and keep jobs with employers that offer insurance benefits.

The first important lesson from Project Access is that: astonishing things can be achieved when community leaders get everyone working together to solve problems.

But perhaps the most rewarding lesson is this: the lower income people who benefit from Project Access understand that fellow members of their community are helping them at little or no cost because they care about them and their community. As a result, most of the recipients respond by taking better control of their lifestyles and health. They show up on time, follow treatment plans, and stay out of the emergency room unless there is a genuine emergency. They come to view themselves as members of a community, and they try, as best they can in often straitened circumstances, to do their part.

Vermonters should consider creating a statewide Project Access model here - before the legislature creates a taxpayer-financed single-payer system, where the government makes the rules, gives the orders, imposes penalties, controls rationing, fixes wages and prices, controls providers, and demands that tax- payers foot the bill.

This is John McClaughry - thanks for listening.

John McClaughry is president of the Ethan Allan Institute, a Vermont policy, research and education organization. He spoke from our studio in Norwich.
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