Like every other business, health care goes where the money is.
The latest local example: walk-in urgent care centers. Chestnut Hill has three within a 15 minute drive. Cambridge has four. “But no companies have rushed to open urgent care centers in Dorchester, Roxbury, or other low-income neighborhoods in Boston,” reported the Globe’s Liz Kowalczyk and Priyanka Dayal McCluskey.
It’s more proof — as if more is needed — of America’s two-tiered health care system, and the growing divide between the haves and the have-nots. And when it comes to access to urgent care centers, Massachusetts health care policy encourages that divide. A holder of commercial health insurance can walk into an urgent care center and seek treatment for whatever ails them. Low-income citizens enrolled in MassHealth managed care plans can’t use urgent care centers unless they get a referral from a primary care doctor.
That referral requirement keeps poor sick people away — just like spikes under a highway bridge keep the homeless from camping out there. At the same time, it also discourages urgent care centers from expanding to poorer neighborhoods.
In his recent inaugural address, Governor Charlie Baker pointed with pride to the state’s leadership on health care policy. “We have the highest rate of health care coverage in the nation. But the story was written across two decades, 10 legislative sessions, five governors, and four presidents,” he said. He also talked about his desire to reduce health care spending. If urgent care centers are supposed to be an alternative to high-priced emergency room care, why make it harder for poor people to access such care?
One health care executive told the Globe the goal is to make it as easy to get urgent care as it is to pick up your dry cleaning. That convenience shouldn’t break down along income lines. Baker should step up and champion a change to state policy that does just that.
The most popular governor in America should also be thinking about social equity issues connected to health care delivery. How about asking the “haves” of the Massachusetts health care system to give back to the have-nots by establishing urgent care centers in less prosperous zip codes, as a condition of their expansion?
A template for that kind of innovative thinking can be found in the conditions set by Attorney General Maura Healey before she approved the proposed merger between Boston-based Beth Israel Deaconess Medical Center and Burlington-based Lahey Health. The resolution that Healey approved calls for the newly created hospital network to cap costs over the next seven years and maintain $71.6 million in financial commitments to support health care services for low-income and underserved communities across the state.
The core mission of health care is supposed to be caring for the sick, not pursuing upscale zip codes for investment purposes. Yet, the business of health care is all about targeting the middle- to high-income sick and their access to health insurance. For example, Partners HealthCare, the state’s largest health care network, operates urgent care centers in Watertown, Newton, Brookline, Cambridge, and one in downtown Boston, near the Common.
Massachusetts officials are currently thinking about licensing urgent care centers, an idea that deserves consideration. As the Globe reported, these facilities are so new to the health care delivery system that there’s no definition for exactly what they are, nor specific rules for how they operate or what illnesses they can treat. That should change.
But so, too, should the idea that it’s OK to make it harder for poor people to qualify for urgent care. Are the poor so different from the rest of us that they should have fewer health care options? We all get sick. We all should have choices about where to seek medical treatment.