Navigating health care’s labyrinth
RURAL Kentucky, and particularly eastern Kentucky, is poor and relatively unhealthy. The people who live in the hills and hollows of central Appalachia face high rates of diabetes, heart disease, cancer and respiratory illness. Some of the area’s problems are common across America: many rural Kentuckians are uninsured, for example, which discourages them from seeking preventive care. Other hazards are distinct to the area. Walking can be a dangerous form of exercise, with oversize log and coal trucks barrelling down the twisty mountain roads. Some people live without running water, or in homes heated by kerosene. In any of these cases, people could do with a local expert to help them navigate the labyrinthine American health-care system.
That is the idea behind Kentucky Homeplace, run by the University of Kentucky. The programme employs about 40 “lay navigators” who work in the poorest parts of Kentucky helping people figure out what they need and how to get it. In one case, Homeplace helped a steelworker who broke his arm on a day off. He had no health insurance to begin with and, after the injury, no income. Homeplace workers negotiated the price of the surgery, and persuaded a hospital to lend a free room. “You can’t let a man go around with his arm broke,” explains Fran Feltner, the director of the programme.
She describes another case, of an elderly couple. The husband was ill, and relied on his wife to keep his medications sorted. But her eyes were clouded with cataracts, and one day she mixed up his pills. He would have gone to a nursing home, but Homeplace intervened: if the state could arrange for the wife to have her cataracts removed, he could go on living at home. That was better for the couple and, as Ms Feltner notes, saved the state a bundle in long-term care fees.
The pragmatic approach has proved effective. In its 2007-08 budget year, Homeplace served 13,000 clients. According to its data, it helped them get $26m-worth of free prescription medicines alone: not bad, on a $2m annual budget. In 2008 the National Rural Health Association recognised Homeplace as the Outstanding Rural Health programme of the year. So its supporters were surprised when the state decided to slash Homeplace’s funding by $750,000 some months ago. Kentucky is facing a serious budget shortfall, but the cut halted the programme for about four months. And the timing was bad, because as the economy worsened more people were calling Homeplace for help.
Fans clamoured for funding to be restored, and in May the Louisville Courier-Journal ran a long article about the problem. Days later, the state announced it would come up with the money for the rest of the year. That is good news for some of Kentucky’s poorest people.
As more states find themselves in financial straits, such programmes will remain vulnerable. At the national level, though, experts on rural health see cause for optimism. Barack Obama’s budget increases regular funding for schemes such as the National Health Service Corps, which helps people through medical school if they pledge to practise in underserved areas. The stimulus package also includes billions of dollars for dozens of rural and community health programmes. The benefits may even spill over beyond rural areas to the rest of the country. The Health Resources and Services Administration, a federal agency, has its own “lay navigators” programme. It is working in Brooklyn and in greater Los Angeles.