Frayed safety net: Pittsburgh’s health care leaders can fill the gap

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It is said that the test of a good society is how it treats its most vulnerable members. Based on the struggles that many Pittsburghers face in obtaining health care, the test results aren’t good — and this in a region that prides itself on top-ranked, quality medical systems.

For uninsured and underinsured patients, even after the dawn of the Affordable Care Act, the options for obtaining medical treatment are far fewer than they were 14 years ago. That’s the disturbing conclusion of the latest installment of “Poor Health,” a Post-Gazette special report that debuted in June and presented its latest stories, written by Sean D. Hamill, in last Sunday’s and Monday’s editions. The occasional series deserves the attention and response of the community’s health care leaders.

One of the reasons that the poor are left with fewer alternatives is the closure of 11 of 39 hospitals since 2000 in Allegheny, Westmoreland, Beaver and Fayette counties. The loss of St. Francis Medical Center in Lawrenceville, St. Francis Central in Uptown and Mercy Providence on the North Side — among the leaders in providing uncompensated care — along with Braddock hospital, Aliquippa hospital, Suburban General in Bellevue and others have forced low-income families and individuals to go longer distances for treatment or stop seeking it altogether.

Contrary to what some might think, this is not a UPMC or a Highmark problem, although UPMC, Highmark and other influential players across the health care landscape can and should be part of a solution. Given southwestern Pennsylvania’s decades-long population decline, the loss of patients and the rise in empty hospital beds, a shakeout involving all regional health providers was inevitable. But what was not automatically forthcoming was a community strategy for how to care for the thousands of people left without accessible care who had little or no means to pay.

In Cleveland, where Northern Ohio’s health care giant, Cleveland Clinic, closed its financially strapped Huron Hospital in 2011, something different happened. Cleveland Clinic built a $25 million health center next to the hospital’s former site. Today those who live in impoverished East Cleveland and who had received primary care from Huron Hospital’s emergency room can now get it from the new center.

This is not what occurred in Braddock, where UPMC closed a hospital in 2010. After the shutdown, Pittsburgh’s top health care network paid for extended hours at a family health center there, created a transportation system to get local residents to doctors and hospitals and opened a dental clinic and social service center.

Those were positive steps, but the result was lacking enough that UPMC’s rival, Allegheny Health Network, will be opening a 4,000-square-foot urgent care center on Braddock’s former hospital site this fall. Even so, it will be one-twelfth the size of the health center built in East Cleveland by Cleveland Clinic.

Southwestern Pennsylvania’s uninsured and underinsured live not only in Braddock, but in other communities and counties surrounding Pittsburgh. The same region is home to UPMC, a $10 billion network with overseas holdings; a revived AHN, now part of Highmark Inc., which has a $4.4 billion surplus; and a range of other independent hospitals and medical centers. All them provide free care to the needy, but it amounts to only 2.5 percent or less of total operating expenses.

Health care is a changing industry that is still adjusting to the arrival of Obamacare, the vertical integrations of hospitals and insurers (like those involving UPMC and Highmark) and declining government reimbursements. Despite the uncertainty and risk, nonprofit hospitals must not lose sight of their charitable missions.

The region’s top medical strategists have built dazzling new complexes and brought the latest advances to their patients. They also are uniquely qualified to plug the holes in Pittsburgh’s health care safety net, if only they have the will.

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