People with a stomach ache and little cash in their pockets have a choice of where to go for low-cost health care on the central Kenai Peninsula.
The Kenai Health Center, Planned Parenthood, Cottonwood Health Center, Central Peninsula Counseling Services and Dena'ina Health Clinic all offer health care at prices people can afford.
"The central peninsula is a lot bigger than people think," said Mary Jane Hanley, public health nurse and the Kenai Health Center's team leader. "There is a lot of need."
People without health insurance coverage in Alaska averaged 17.7 percent between 1999 and 2001, according to the U.S. Census Bureau.
Some of these people turn to Medicaid, a federal and state program providing medical assistance for certain individuals and families with low incomes. But they must qualify for the program and a health care provider that accepts it.
A visit to the doctor can range anywhere from $60 and up, and does not include prescriptions and additional testing.
Although some people have insurance, they can be underinsured or unable to pay the insurance plan's deductible.
These low-cost clinics do not staff doctors, with the exception of Dena'ina Health Clinic, but can meet patients' basic health care needs with nurse practitioners, who give exams and write prescriptions.
The Kenai Health Center is an Alaska Public Health nursing facility and is frequented by people looking for accessible health care.
"It provides services to well people," Hanley said.
The clinic does not charge people under 21 or for the treatment of communicable diseases, such as tuberculosis or sexually transmitted diseases.
The center also offers family planning and reproductive health services at a lower cost. For example, a pack of birth control pills that cost $30 at a pharmacy is $1 at the clinic.
The clinic receives a large volume of people, Hanley said.
"Health care is so expensive," she said. "Even with insurance, people have to pay up front."
Because of the high expense, many times people will put off health care that would be a simple problem in the beginning, but turns into something more serious, she said.
Finding low-cost health care becomes more difficult for patients seeking additional help, she said.
If the patient is covered by Medicaid the clinic will help them look for doctors who are Medicaid providers.
About one-third of the children who visit the clinic are on Medicaid, Hanley said. It is easy to get children in the program, but adults are less likely to be covered, she said.
Depending on the individual's health problem, there may be an affiliated group to help access money; lung associations or breast and cervical cancer groups often provide money for health care, she said.
Another option for men and women looking for low-cost health care is Planned Parenthood in Soldotna.
The organization is supported by grants and offers health care to people at all income levels and ages.
While it accepts both Medicaid and insurance, the clinic's advantage is it requires no proof of income to see a nurse practitioner.
The clinic only asks people to be honest when filling out the information, said Jennifer Cowan, Planned Parenthood co-manager and licensed practical nurse.
"We are pretty easy to work with," she said.
The clinic will charge the minimal amount or accept donations for some of its services, depending on the patient's income, Cowan said.
However, there is usually a grant for everyone, she said.
The clinic offers cervical and breast cancer screening and STD screening.
Also, it provides other various medical services, such as treating urinary tract infections and ear infections.
Planned Parenthood walks patients through the intimidating paperwork when they seek extended treatments and tests, Cowan said.
Some doctors and Central Peninsula General Hospital are covered under the same grants as the clinic. The clinic points people where to go, so they are still covered by the grant vouchers.
At the Cottonwood Health Center in Soldotna people are charged a percentage off the regular charge based on their income and household size, said Debbie Standefer, Cottonwood Clinic operations director. Patients may pay as little as $10 a visit or as much as a visit to the doctor.
About one-third of the clinic's patients use Medicaid, and it accepts insurance.
If a patient is underinsured, with the insurance company only paying 80 percent of the bill, the clinic will discount what the patient pays out of pocket, depending on income.
Nurse practitioners write prescriptions, but patients cannot always afford them, Standefer said.
The clinic carries some samples that can be given away. Otherwise, the clinic helps people with assistant programs offered by pharmaceutical companies.
The Indigent Drug Program is not advertised, she said.
"It's a pain," she said about the paperwork, "but (the program) is a wonderful thing."
The provider and patient fill out an application and send it to the pharmaceutical company. It takes four to six weeks to process the application. The company will then issue several months, sometimes up to a year's worth, of medication.
"We recognize that it is a huge problem," Standefer said about finding affordable medication. "If you don't have (money), you can't pay it."
Moreover, the clinic is anticipating the operation of a dental clinic in March.
"People are loosing their teeth," Standefer said.
Because people have few places to go on the Kenai Peninsula for low-cost dental care, either they have to travel to Anchorage to find a dentist who accepts Medicaid, or to the dentist at the Anchorage Neighborhood Health Center, which is structured similarly to Cottonwood Clinic.
Some dentists on the central peninsula will accept payments, she said.
"A lot of people don't want to ask," she said. "They are grateful if a program is there, but they are not going to beg."
Psychiatric care is offered at Central Peninsula Counseling Services. It provides a full range of behavioral health care on a sliding fee scale. CPCS also will assist patients in finding ways to pay for prescriptions, usually through pharmaceutical company drug programs.
In addition to the other low-cost health providers, Alaska Natives and American Indians are able to seek medical assistance at the Dena'ina Health Clinic, a Kenaitze Indian Tribe program. Patients need to bring a certificate of Indian blood to receive care. Their non-native spouses also are eligible for treatment.
The clinic offers primary urgent care and a dental program.
If the patient's medical need is outside the clinic's ability, they will be referred to the Anchorage Alaska Native Medical Center in Anchorage, said Barbara Norbeck, Dena'ina office manager.
The clinic pays insurance deductibles and picks up prescription costs not paid for by insurance companies or Medicaid.
"We work to keep the Native population in Native health care facilities," she said.
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