A pressing question for all health-care providers is, “How do I do what is best for the patient if the patient cannot afford a higher level of treatment?” For example, I work in primary care, and many of my mental-health patients need a consult with a psychiatrist or ongoing counseling.

A patient on a limited income cannot afford to pay $300 for the psychiatrist visit and another $100 for counseling sessions. When the choice boils down to eating or becoming mentally well, patients are going to choose to eat. — Jenny Willmore, PA-C, Anthony, Idaho

Inequality to health-care access, especially access to mental-health treatment, is rampant in this country. The United States is the only industrialized nation that continues to have a health-care system established on employee-based private health insurance programs that are for-profit industries with an obligation to shareholders above the obligation to individual patient care.

The health-insurance industry continues to reap substantial profits and to divest funds into lobbying against any movement to a single-payer or government-sponsored nonprofit system. Employers can no longer afford to offer the health-insurance plans once universally provided to employees and have either stopped providing insurance or switched their workforce to part-time workers who do not meet the criteria for health insurance and cannot afford to purchase insurance on their own.

It is outrageous that the cost of getting ill accounts for roughly two-thirds of all personal bankruptcies in the United States. Adequate health care should be available to all residents, regardless of socioeconomic class or employment status.

To help patients like the one described, familiarize yourself with the resources in your community, including any local, state or federally subsidized programs. Programs are also available through some of the large pharmaceutical companies to get reduced prices for patients without prescription plans. Charity care is available in most states, but waiting lists are quite long.

Finally, form a relationship with local clinics and caregivers and, most important, with your legislators and regulators, and encourage them to expand existing programs to those with need. — Claire Babcock O’Connell, MPH, PA-C (175-3)


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a question, submit it here.