healthcare options for the uninsured
by kathy robinson, md

Who’s writing this article?

I am a family practitioner, trained in standard Western medicine, and working in public health at the Buncombe County Health Center. What’s it about?This article is about ways to access Western medicine in Asheville and Buncombe County. Similar programs exist in many counties but each area has its own unique set of advantages and challenges. This is not about finding alternative or complimentary medical care or psychiatric care.

Introduction

In Buncombe County there are over 20,000 people without health insurance. Even for people who are not much interested in Western medicine, there are reasons for having an established health care provider. A provider can get you access to pap smears, mammograms, cholesterol, colon cancer, thyroid, diabetes and other screening tests. In addition, when dealing with serious illness or injury, it is good to have a practitioner who knows you to help get through the system. A good family practice type provider can help you understand your options even if you decide against Western medical treatments. In this community, your provider can refer you to Project Access (see last section) to get specialist care or expensive tests at no cost.

BUNCOMBE COUNTY HEALTH CENTER (BCHC) 250-5000
Healthcare at BCHC is provided by physicians, mid-level practitioners, nurse screeners, nurses, and CNAs (certified nursing assistants). It is run like a large family practice office. Payment is based on income. We have a large pharmacy and a laboratory. Mammograms and ultrasounds are available. Prenatal care is provided and WIC (Women, Infants, and Children) nutritional assistance is available. We are fortunate to also have access to Spanish and Russian interpreters, behavioral health practitioners, nutritionists, social workers, and health educators. There is a dental clinic that provides comprehensive services for children and limited services for adults. The Disease Control Clinic provides confidential testing for sexually transmitted diseases and the TB clinic provides care for people with tuberculosis or positive TB tests. We also have a large Immunization Clinic that provides immunizations for anyone in the community.

WNC COMMUNITY HEALTH SERVICES (WNCCHS) 285-0622
This group, headed by Dr. Polly Ross, provides ongoing family practice type care to large numbers of uninsured and underinsured patients in this community. WNCCHS has physicians, mid-level practitioners and social workers, many of whom are bilingual. They have two clinics, the Ridgelawn Clinic and the Minnie Jones Clinic.

RIDGELAWN CLINIC
The Ridgelawn Clinic does general primary care and provides comprehensive care for people with HIV/AIDS. This clinic accepts insurance, but for those without insurance charges fees based on a sliding scale. They have a dental clinic and a pharmacy.

MINNIE JONES CLINIC(in the Pisgah View Apartments)
This clinic provides acute care to anyone living in the 28806 area code who has no insurance, to anyone who is homeless, and to anyone who is an immigrant. Patients at this clinic with chronic problems are referred to the Ridgelawn Clinic or to BCHC for ongoing care.

ASHEVILLE BUNCOMBE COUNTY CHRISTIAN MINISTRY(ABCCM)
Medical Clinic 259-5339
The ABCCM Clinic is run by volunteer health care practitioners from the community and provides urgent care services to uninsured residents of Buncombe County. It has limited hours, Monday, Tuesday, and Wednesday from 9-11:30 am and Monday and Thursday nights from 5-8:30 pm. Patients with chronic problems are referred to other clinics for ongoing care. ABCCM is set up to do urgent medical care only, it is not designed to give spiritual care and you do not need to be Christian to get services there.

THREE STREAMS FAMILY HEALTH CENTER 285-9725
Three Streams is run by four men: a physician, a physician assistant that is also a priest, a social worker and a chaplain. They provide medical care with the addition of therapy and pastoral care. This is a Christian facility; they pray with their patients as an integral part of their care.

PROJECT ACCESS
Project is a nationally recognized program that is run by the Buncombe County Medical Society. It is designed to provide the uninsured with access to specialist care at no cost. When a primary care provider decides that a patient needs the care of a specialist, this care can be requested through Project Access. If the patient qualifies and the care is available, the patient is issued a Project Access card. This card is used as an insurance card to pay for tests, visits to the specialist and medications. It is not a perfect plan, some specialties do not participate, and others limit the number of visits for Project Access patients. However, it is the best system I know of for getting specialist care to the uninsured without national health insurance.

MADISON COUNTY HEALTH DEPARTMENT 649-3531
This health department does not do primary care for children or adults. They are staffed by mid-level providers and have prenatal care, family planning,and a sexually transmitted disease clinic. Patients wanting primary care are referred to the Hot Springs Health Program, which has several clinics, but they do not accept any sort of sliding scale for fees. They do have some funds for patients that are unable to pay, but these funds are used at the discretion of the provider only. The main number for the Hot Springs Health Program is (649-3500).

HAYWOOD COUNTY HEALTH DEPARTMENT 452-6675
This health department does not do primary care for adults, but has an array of preventive health services including Family Planning, Child Health, and Adult Health. This clinic is run by nurse practitioners and midwives. They accept sliding scale fees. Patients requiring primary care are referred to the Good Samaritan Clinics with offices in Waynesville (454-5287) and Canton (648-8676). The Good Samaritan Clinics are staffed by physicians and mid-level practitioners. Many are bilingual. They accept sliding scale fees.

HENDERSON COUNTY HEALTH DEPARTMENT 692-4223
This clinic does not do primary care for adults. They have the following programs: Sexually Transmitted Disease Clinic, Family planning Clinic, Breast and Cervical Cancer Prevention Program, Prenatal Clinic, and Child Health Clinic. Patients needing adult primary care are referred to Blue Ridge Health Center (692-4289). Blue Ridge does accept sliding scale fees. There is also the MAHEC family practice clinic as noted above.

Kathy Robinson M.D., practices medicine, sings with Womansong, writes, andmakes stained glass sculptures in Asheville. She can be reached at rubberduckyglass@aol.com.