March 26, 1999
By Ed Martinez
Lucien Wulsin's comprehensive analysis of healthcare services for the uninsured ("Clinic, Counties and the Uninsured," San Diego, March 5) substantiates a fact that community clinics have long struggled with, i.e., local funding of medical services for the uninsured indigent have declined steadily in terms of actual dollars as well as a percentage of the county health budget. Mr. Wulsin's data documents the fact that San Diego County spends less on healthcare for the uninsured than any other California county with a population greater than one million ($73 per uninsured patient per year vs. the average annual cost of $248 experience by the other five study counties). Mr. Wulsin also points out that in San Diego County, the uninsured population numbers 645,000 —and, this number continues to grow daily as state and county funding programs restrict access to basic primary care services by tightening eligibility requirements to the point that they actually serve as participation "barriers."
This shortfall in funding and restricted access to essential healthcare services represents a crisis situation relative to the delivery of essential medical services to the county's Latino community. In fact, the data suggests that the Latino community, which accounts for slightly more than half of the uninsured in San Diego County, will be disproportionately impacted by cutbacks in services currently available to the uninsured.
It is important to note here that this uninsured populations is a working population: According to 1990 U.S. Census Bureau data, Latino males demonstrate higher labor force participation (83.1%) than the average participation rate for all males statewide (78.0%). It should also be noted here that a significant number of this uninsured population is employed by small employers not offering insurance coverage. This population, then represents the working poor in our community not able to afford health insurance coverage.
Until San Diego County is able to respond to the fiscal realities of maintaining an effective safety net system for those in need, thousands of uninsured men, women and children will be locked out of basic medical services that so many of us take for granted. In the short term, I do not anticipate any significant improvements in funding services for the uninsured. San Ysidro Health Center and other community clinics will continue their important work by reaching out and serving the healthcare needs of our low-income, medically underserved populations. Collectively, we look forward to collaborating with county and state officials to develop enhanced funding programs. The Board of Supervisor's recent division to allocated Tobacco Settlement monies to health-related services represents a significant breakthrough in community-based health planning activities. The Board clearly signaled its intent to create an open forum process that would encourage the active participation of interested individuals and community organizations. This invitation represents a great opportunity for our community to develop a more humane system for delivering medical care to those in great need.
(Ed Martinez is the CEO at the San Ysidro Health Center)
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