In 2007, the Centers for Disease Control report on the nation’s health stated that nearly one in five U.S. adults — more than 40 million people — reported they did not have adequate access to the health care they need.

Twenty percent of those 40 million lacking health care live in rural areas. In Montana, approximately 70 percent of the state’s uninsured live in rural communities.

The wide open spaces, independent living and rugged environment that Montana is known for can be especially challenging for many rural communities, where health care isn’t readily available. Even those of us living in an urban setting are faced with similar challenges: The cost, transportation, long distances, fuel expenses, and lack of available physicians all are barriers to health care.

Lack of insurance

In 2006, it was estimated that 12 percent of Montana’s adult population was unable to visit a doctor during the past year due to cost. According to the 2006 Census Bureau Population Survey, more than 17 percent lacked health insurance. Even though the median household income in Lewis and Clark County is about $41,800, approximately 21 percent of our county residents lack health insurance.

Although employment is the major source of private health insurance, many uninsured people work for firms that do not offer coverage. About half of all Montana employers offered health insurance to their employees in 2006. But, due to the high cost of premiums, many Montana businesses simply cannot afford to offer employees health insurance. A detailed analysis of the 173,000 uninsured Montanans in a 2004 State Health Planning Grant Survey revealed that 77 percent were employed. The survey also found being uninsured was not voluntary, with 90 percent of the uninsured reported being unable to buy health insurance after paying for food, clothing and shelter.

Transportation/

cost of gas

Missing routine or preventive medical care can lead to the need for emergency care or even to preventable hospitalizations. The high cost of gas, not having a vehicle available or limited access to public transportation can lead to difficulty in seeking medical care. According to the CDC, nationally, 10 percent of low-income women aged 45-64 reported that they delayed obtaining medical care due to lack of transportation. Here at the Cooperative Health Center, recently as many as seven appointments were canceled in a week due specifically to the high cost of fuel.

Community Health Centers

With these health care challenges, community health centers, such as the Cooperative Health Center here in Helena and the Parker Medical Clinic in Lincoln, are filling critical gaps in health care and are vital links to both rural and urban communities — providing high quality health care regardless of the patients’ ability to pay. Patients are charged on a sliding fee scale to ensure that income or lack of insurance is not a barrier to care.

With only 14 community health centers in Montana, which treated over 79,000 people in 2007 at 11 clinic sites, we are fortunate to have one health center here and the recently opened clinic in Lincoln.

Since opening in 1993, the CHC improves and protects the health of county residents through education and direct care for people who could otherwise fall through the cracks of the private health care system. Services include physicals, pap tests, preventive health procedures, general dental care, vasectomy, newborn and pediatric care, diabetic and chronic disease care, mental health counseling, and Medication Assistance Program, which helps low-income patients apply for free or low-cost medications through pharmaceutical companies’ patient assistance programs. Four mornings a week, the CHC operates Health Care for the Homeless, a daily clinic for homeless people located at God’s Love shelter.

The CHC has negotiated agreements with St. Peter’s Hospital and numerous specialist care providers to honor the CHC’s sliding fee scale when CHC patients are referred for external services. The Helena CHC target population consists of almost 17,000 residents who live below 200 percent of poverty. In 2001, 24 percent of visits were with uninsured patients, by 2007 that number had climbed to 60 percent. The clinic served 5,590 individual patients in 2007 and currently sees an average of 150 new patients each month.

After opening a year ago, working in partnership with the CHC, the Parker Clinic medical staff provides a full range of family health services, placing a strong emphasis on prevention of serious illnesses and injuries. In Lincoln, a rural community of approximately 1,200 residents, the Parker Clinic is now a medical home for over 700 patients and it’sgrowing.

Our community health centers are working hard to overcome the barriers to health care by providing accessible, comprehensive quality health care to all county residents. To find out more or make an appointment stop by the Cooperative Health Center or call 443-2584; Parker Medical Clinic in Lincoln, (406) 362-4603.

Melanie Reynolds is the health officer at the Lewis and Clark City-County Health Department. The Health Department’s mission is to improve and protect the health of all Lewis & Clark County residents.