Once again, discussion of healthcare reform is taking the national stage. This is an extremely complicated and important topic that involves many issues including cost, reimbursement, insurance and regulatory oversight to name only a few. Access to care is one issue that must be a central part of the discussion for physicians, nationally and locally.

 

In Nashville, Metro General Hospital operates as the community's public hospital to provide access to care for all the city's residents – whether uninsured, underinsured or insured. This is why Nashville leaders are seeking federal assistance for the hospital to help it weather the economic downturn and continue to play its century-old role in patient care and medical education.

 

Access to care is on the minds of many people in Nashville, especially those who provide healthcare. In the current economy, an increasing number of Nashville residents face uncertainty about their future insurance coverage. Many are already living without coverage. Much of their uncertainty is focused on the question, "Where can I go to receive care if I need it?" Some physicians are now faced with the question, "Where can I send my uninsured patients when they need the acute care services of a hospital?"  

 

The answer to these questions has always been Metro General Hospital. However, just as individuals and medical practices are dealing with the realities of the economic recession, so is Nashville's public hospital. Proposed budget cuts for Metro General Hospital could affect access to care for thousands of people throughout the city. Residents in 15 zip code areas of Nashville – ranging from west Nashville to Antioch – were admitted to the hospital in 2008.  

 

While inpatient care is an essential part of Metro General's services, its outpatient services respond directly to the need for healthcare access in Nashville. For example, Metro General Hospital operates both primary care clinics and specialty clinics where uninsured patients can receive care. These clinics are an important part of the care given to patients who go to the Metro General emergency room and need to receive regular follow-up for their severe heart disease, cancer or other life-threatening conditions.

 

While Nashville's network of community healthcare centers operates to provide primary care services, they cannot care for patients with specialty or acute care needs. Patients regularly access Metro General's specialty clinics. The clinics ensure not only access to care, but also continuity of care for serious chronic illnesses.

 

Physicians should be concerned about what happens at Metro General Hospital because its services can impact the care that they provide to their own patients. Patients who even temporarily do not have insurance are likely to postpone or skip recommended healthcare services for cancer prevention, cardiovascular health and diabetes management. Through the public clinics at General Hospital, patients without insurance can still receive these services. Without this attention, patients who regain insurance, may return to private physicians with illnesses that require a higher level of care or with advanced, life-threatening conditions. 

 

Access to care also impacts the overall health and welfare of the community. Metro General Hospital is an essential part of the city's overall public healthcare system. The resources of a public hospital would be essential in the event of a public health emergency or disaster situation. These resources are no less essential when the city's families, workers and children – who are uninsured or underinsured – face personal illnesses or injury emergencies and require care.   

 

Access to care also assumes that enough physicians are available within a community. Metro General Hospital plays an important role in training physicians, dentists and other healthcare providers who form the backbone of the healthcare system in Tennessee and in the nation. Metro Nashville General Hospital serves as the principal teaching facility for Meharry Medical College, the largest private, comprehensive, historically black institution for educating health professionals and scientists in the United States. The partnership between Metro General Hospital and Meharry Medical College is recognized nationally as a unique healthcare resource. Metro General Hospital not only provides care but also provides training for future healthcare providers; this is crucial to our city, state and national healthcare infrastructure. At a time when the federal government is providing aid to sustain the national infrastructure in response to the recession, there is a compelling case for aid to General Hospital because of its role in the medical academic infrastructure of our country. 

 

Why should physicians be concerned what happens at Nashville's Metro General Hospital? As medical providers and people with knowledge about the importance of healthcare services to a community, physicians should serve as advocates, not only for their own patients, but for all people in need of healthcare and medical services. Nashville's healthcare infrastructure can only remain strong if it includes access to care for all its residents.

 

What happens at Metro General Hospital could be a harbinger of changes in the healthcare delivery system that will impact physicians and their patients for years to come. Ensuring access to care through the use of community public hospitals should be one of the most important topics in any local or national discussion of healthcare reform.