Can California's Counties Meet the Need of Low Income, Uninsured Men with Prostate Cancer?
California's 58 counties are crucial providers of health care services to individuals who are unable to access mainstream medical care and related services. Counties are the providers of last resort and their success or failure has a dramatic effect on access, affordability, and availability of health care services for the uninsured. As funding sources shrink, county medical resources for the uninsured and underserved are disappearing. Since 1964, the number of counties operating inpatient hospitals has decreased dramatically from 50 counties and 66 facilities to 19 counties operating 26 county inpatient hospitals. It is the norm rather than the exception that these facilities have limited hours for specialty clinics, long waiting periods, inflexible health care delivery systems, and are not equipped to provide state of the art medicines or treatments for complicated illnesses such as prostate cancer. A recent survey of California counties by the IMPACT Program found that 32 of the 58 California counties do not have a facility, either county run or through contract with a privately owned hospital, that an uninsured man can go to if he is in need of medical care for prostate cancer. The remaining counties are restricting services due to budget cutbacks, making it even more difficult for men in need to receive treatment for their prostate cancer.
County Case Studies
Alpine County. Alpine County has no urologist. Men with prostate cancer are referred to the University of California, San Francisco for medical treatment. This is a 210-mile trip each way.
Contra Costa County. The county health facility has undergone a series of cutbacks. Uninsured individuals are often required to pay for treatment in advance of receiving services and men who earn between 101% and 300% of Federal Poverty Level (FPL) are required to pay a partnership fee for treatment as well as cover the cost of their medications, which may exceed $1,000 per month.
Alameda County. Alameda County has one of the largest African American populations in the State. African American men are 3 times more likely to be diagnosed with prostate cancer than white men. The Highland Hospital Urology Clinic, the only county-run urology clinic, is reducing operations due to budget cuts.
Modoc County. Modoc County Hospital does not have an urologist on staff, nor does it have an Oncology Unit. Patients are referred to Mount Shasta in Siskiyou County (130 miles away), Redding in Shasta County (150 miles away).
IMPACT Program Responding to the Need
Faced with high numbers of people without health insurance or health care has overloaded California's healthcare system. As funding sources shrink, county medical resources for the uninsured and underserved are disappearing. IMPACT has responded to this need by reducing barriers to accessing needed prostate cancer treatment services by creating a sound infrastructure for prostate cancer treatment including over 700 providers in the communities where patients live and work. The Program has also developed linkages with organizations throughout the state, which provide free or reduce cost prostate cancer screenings in an effort to provide a full continuum of prostate cancer screening, detection, and treatment for uninsured men.