As a small community pediatrician and allergist in Texas, ten years ago I was asked to provide health care for our local jail inmates. When our County Judge asked me to do this, my only response was “why me?” Her answer was a simple one….because you can do it.
I took over a program that was costing the county $15,000 per month, which might not seem like much. After all, that included the physicians fees, emergency room care, all the medications utilized and even a standby dentist. However, when I reviewed what we were spending and why we were being charged so much, I was astounded. We were funding a health care system that subsidizing a local clinic to some extent, but more imporantly the jail health care system had become a referral base to our local emergency room. It turned out that the doctors involved would not go to the jail after-hours and on weekends, and thus any patient claiming they had a medical problem was being referred to our local emergency room. Unfortunately for the county, this was the most expensive health care provided in our community. Therefore, the initial goal was to create a system that provided good health care for the patients, but had the health care provided meet the level of health care required for the existing medical problem. Second, brand name medications were routinely prescribed as the primary course without consideration of any alternatives. In fact, often the inmates were recommending what they would prefer to the physician extender, who was routinely seeing patients. So what were we do do? What could we do? And finally what should we do?
I recruited our local EMS service to become screeners for the inmates when an medical problem existed afte-hours and on weekends.. Slowly, but surely, with some additional training from me, they became proficient at differentiating true emergencies from the numerous pseudo-health problems frequenting the jail. Needless to say, as Medical Director, I was routinely available whenever questions occurred. Secondly, I scheduled twice a week visits for the routine inmate care. Third, patients received the care they needed medically rather than what they requested or wanted. Fourth, a generic formulary was provided as a first line of medications. And fifth, common sense became our guiding light.
The cost of health care dropped from $15,000 per month to $5,000 per month and has stabilized for 9 years. Inmate patients see the same physician each visit rather than whomever is in the emergency room, thus allowing continuity of care. And finally, we are developing a concept of health care in Washington County, Tedxas that allows for more people to be served at a higher level of care and for less cost—a system that the state and the country might wish to immitate.
If we can do this, so can they!
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