Helping the Uninsured – Can Nurses Make a Difference?
Hundreds of children are born uninsured every year.
One in six Americans was living in poverty in 2008, and that number has risen in 2009.
Many of these people have gone without—and continue to go without—health insurance.
We asked Jane Dellert, a nurse of 41 years who has treated uninsured children at low-cost clinics since the 1990s, what she thinks about the current healthcare crisis and what nurses can do to help the uninsured.
Scrubs: How did you get involved in working with the low-cost clinics?
Jane: For many years, the county Health Department’s division of Public Health Nursing has run a clinic for children without insurance to receive vaccinations and well child care. The clinic uses the Early and Periodic Screening and Developmental Testing plan used by Medicaid. In the 1990s, the public health nurses worked with PNPs employed by a local hospital in a clinic for low-income families to handle this well child clinic. I worked per diem in this clinic with my PNP colleagues. When my PNP colleagues went on to other work at the time that the hospital turned its clinic over to private providers, I was approached by the public health nurses to work as an independent contractor for the county well child clinic, and have done so ever since.
I have been a nurse for 41 years and a PNP for 23 years. As a PNP, I have worked in private practice and college health as well as in low-cost clinics. Currently, in addition to my faculty position at Seton Hall, I work one afternoon a month in this clinic for uninsured children, and two afternoons a week with a pediatric allergy and asthma specialist.
Scrubs: What are your hopes for the future of healthcare?
Jane: I see the fragmentation and confusion in our present patchwork of health insurance as the biggest barrier to providing the healthcare that children need, whether the children are covered by health insurance or not. Health insurance coverage can change at the drop of a hat, and families can be left scrambling to find ways to obtain the routine healthcare that children should have to remain healthy, never mind care for chronic conditions or catastrophic illness.
In addition, healthcare providers face constant confusion over what services will be reimbursed and what fees will actually be paid for services rendered, plus mountains of clerical work to submit claims for healthcare services given. Even a small healthcare practice must employ several people to deal with the issues of reimbursement in order to remain economically solvent and therefore available to their clients.
In the clinic for children with no health insurance, I see the consequences of losing insurance, not qualifying for government insurance (Medicaid) or not being able to afford individual health insurance policies. In private practice, I see the struggle to keep insurance, the confusion around keeping access to services when insurance changes and the tremendous burden of dealing with many different health insurers’ systems.
I hope to see fragmentation, confusion and gaps in services eliminated, and that all providers of health services (physicians, nurse practitioners, physician’s assistants, pharmacists, dentists, etc.) will be able to efficiently and fairly receive appropriate compensation for the services rendered. And I hope that opportunities for healthcare fraud will be significantly curtailed.