Despite being disproportionately low income and uninsured, many safety net clinic patients in New Orleans had fewer problems paying for care post-Hurricane Katrina. There were also fewer cases of medical debt and inefficient care compared to most American adults, according to a new survey from the Commonwealth Fund.
Overall, the report, Coming Out of Crisis: Patient Experiences In Primary Care In New Orleans, Four Years Post Katrina, found that among all the clinic patients surveyed, only 27% went without needed healthcare because of cost—compared to 41% of adults nationwide.
In 2007, New Orleans' major public hospital and adjacent ambulatory sites were closed, but the Department of Health and Human Service provided a grant to Louisiana to support a network of independent neighborhood primary care centers to increase access to care and develop an organized system of care.
The Commonwealth Fund survey was conducted 18 months after the grant was awarded to assess the impact of the project on patients' access to care and experiences. It also looked at lessons for national and state leaders on the value of strengthening primary care for vulnerable patients.
When the authors compared the 2009 survey of patients in 27 New Orleans health clinics to findings from The Commonwealth Fund's 2007 Biennial Survey, a representative survey of the nation's general population, they found that the clinic patients tended to be less worried about affordability.
Almost half of clinic patients (49%) said they were confident they could afford needed care if they became seriously ill—compared with only 30% of adults in the general population.
In addition, medical debt also seemed to be less of a concern for clinic patients, with 34% reporting medical bills or debt problems compared to 40% nationwide. Unpaid medical bills appeared to be a far greater problem among all U.S. adults than among clinic patients (28% vs. 18%).
Clinic patients also reported receiving care that was more efficient than the US norm. For instance, only 4% of the clinic patients reported duplicate medical tests, or said that medical records or test results were unavailable at their appointment, while 34% of patients nationwide said they experienced those problems.
The clinic patients also said they had more confidence in the healthcare system, with three quarters saying they would be very confident in their ability to get high quality and safe medical care; only 39% of adults nationwide said they were very confident that they could get high quality and safe care.
Other findings from Louisiana included:
- 88% of patients found it is easy to get same or next day appointments when sick, to access medical advice via telephone or during regular practice hours, or to get after hours care (in the evenings, on weekends or on holidays).
- 79% patients reported exceptional communication with their doctors and 85% said that their health needs are "very well" met in the clinics. Adults who reported excellent patient experiences, easy access to well coordinated care, and exceptional patient doctor communication were more likely to get recommended preventive services.
Overall, the findings revealed that strengthening primary care could be instrumental in helping to move the nation to a high-performance health system, said Commonwealth Fund Assistant Vice President Melinda Abrams, a co author of the report.
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.