Spokane physicians are exploring a program under which they and other health-care providers would offer free or low-cost medical care to low-income, uninsured residents here.


The program, which is called Project Access and is modeled after programs of the same name in other communities, aims to coordinate charity care provided by primary-care doctors, specialists, hospitals, community-based clinics, and pharmacies, says Dr. Samuel Selinger, a cardiovascular and thoracic surgeon here who is leading the effort.


The first Project Access was launched six years ago by doctors in Buncombe County, N.C., and the program there has been extremely successful by many measures, Selinger says. Now, county medical societies in more than a dozen U.S. communities have adopted the program and more than 30 others are in the process of implementing it, he says.


Although the Spokane County Medical Societys board of trustees has approved the effort to launch the program here, it could be two years before the program begins, Selinger says. Hes now forming committees to talk to doctors, hospitals, government and social-service agencies, and others, he says.


The process takes time, because while we have a superb blueprint from these communities that have adopted (Project Access) we do have to take into consideration the resources and the various organizations that we have uniquely developed in Spokane and adjust the outline. We dont want to be blind to whats already here and try to impose something that doesnt fit.


Through Project Access, doctors pledge to see, free of charge, a certain number of uninsured patients each year whose incomes fall below a predetermined level, usually some percentage of the federal poverty level. The doctors are able to refer those patients for specialty care, admit them to hospitals for inpatient care, and prescribe medications for them just as they would for any other patient. With the exception of the prescriptions, for which patients would be charged a nominal (typically under $5) fee, all of that care would be free. A computer system would track patients through the system, and tally the care provided.


Through Project Access programs, other organizations also can agree to provide free services. In Buncombe County, for example, the county government pays for medication costs of about $200,000 a year, while a medical clinic donates computer-tracking services, and Medicaid offices screen and enroll patients for the program, says Alan McKenzie, CEO of the Buncombe County Medical Society, the organization that developed and administers Project Access there. Hospitals and labs typically also agree to provide charity care through the program.


Such a coordinated approach has had several benefits in communities that have Project Access programs, Selinger says.


First, the low-income, uninsured population targeted by Project Access becomes healthier because uninsured people dont wait to seek medical care until theyre very ill and potentially harder to treat, which is a common scenario, he says. In Buncombe County, 80 percent of patients in Project Access reported improved health status, Selinger says. Better health has allowed many Project Access patients there to get jobs and obtain private health insuranceanother goal of the program, he says.


Doctors, hospitals, and pharmacies benefit because the charity care they provide is more efficient and cost effective, Selinger asserts. Patients receive appropriate specialty care and medications, making it less likely that theyll need to be treated on a recurring basis by primary-care doctors or in emergency rooms.


In Buncombe County, theres an abundance of evidence that Project Access is working, McKenzie says. In the second year after the program started, 8 percent of the people in the program made emergency-room visits, down from 17 percent the year before it started. By 1999, the amount of charity care provided by hospitals declined by 23 percent because of the improved health of the target population.


The public-health district was able to provide primary care to an additional 3,000 low-income, uninsured residents each year because the districts staff didnt have to spend so much time on the phone and doing paperwork trying to secure specialty care and other services for its patients. Over the past five years, the per-capita cost to county residents of charity medical care has plunged by 40 percent, he says.


We set about constructing a system to do the right thing the smart way, McKenzie says. We have created a community thats providing 100 percent access to the full continuum of care to every low-income, uninsured person in our community. This is much more than a health-care access charity system; this is a means for enhancing the overall economic strength of the community.


Selinger says an important part of a Project Access program is the computer tracking that takes place. Health-care providers can see whether the value of the care theyre donating is making a difference and can use the information to make the program even more efficient, he says.


I think thats one of the things that makes this program somewhat unique, Selinger says. You can track it fairly efficiently and not say, Yeah, we think were doing something.


In Spokane County, about 33,000 people were identified in the 2000 U.S. Census as being uninsured, Selinger says. Some of those people are children, who are eligible for medical care through other programs, and some may not be considered low income for the purposes of Project Access, he says.


Nevertheless, with the downturn in the regional economy since the census was conducted, the number of uninsured people likely has grown since then, he says.