Do you know how your healthy self turns into an unhealthy mess? One missed check up at a time.

Health insurance is hard to come by, particularly if you are on the lower end of the pay scale. But when you missed one check up too many for that killer headache, it really becomes a headache and a burden for your loved ones, yourself and society.

Marta Yánez, 59, a Maryland resident and an immigrant from Ecuador, has a history of high blood pressure and suspected some heart problems, but she had no health insurance and the doctor fees were prohibitive.

Proyecto Salud was her answer.

After nine years, Proyecto Salud (Project Health) has become the main primary health provider for immigrants with no health coverage in Montgomery County, Maryland. Yánez is one of them. She became a patient of the clinic shortly after it started providing services.

"I have been treated here for high blood pressure, and I have also been checked with electrocardiograms…(for) any (health) concern I have I come here…" said Yánez, who adds that Proyecto Salud is of "great help to us who do not have health insurance". She even brought her 27-year-old daughter for some health tests at the clinic.

The latest data published by the US Census Bureau shows that close to 47 million people in the United States are uninsured. Around 100,000 of them reside in Montgomery County, Maryland, according to the County’s statistics.

The Primary Care Coalition of Montgomery County was established to administer programs and award grant money to the safety net providers.

"In 2000, a coalition study found that caring for our estimated 80,000 to 100,000 uninsured residents left our hospitals with an annual deficit of $53.3 million due to uncompensated care. This deficit is passed on to other health care consumers in the form of higher insurance premiums and hospital rates," said Montgomery County Council member George L. Leventhal.

Proyecto Salud – officially known as Montgomery County Language Minority Health Project (MCLMHP) – is part of the Primary Care Coalition, which includes eight medical centers throughout the county. The network covered the needs of 13,000 patients during 2006. According to Dr. César Palacios, the Executive Director of Proyecto Salud, the county’s goal is to offer health services to at least 40,000 uninsured patients by the year 2010.

A total 2,500 patients (20%) were seen at Proyecto Salud, which has more than 4,000 registered patients. Dr. Palacios predicts the number of patients seen by the entire network may reach 17,000 during 2007.

More than 80% of the patients who look for help at Proyecto Salud are Hispanic immigrants. This shouldn’t come as a surprise since the US Census Bureau reports that in 2005 more than a third of the Hispanic population (32.7%) was uninsured. The same applied for almost a fifth of the Black population (19.6%) and a slightly smaller proportion of the Asian population (17.9%).

Due to the overwhelming majority of Hispanics among its patients, all members of Proyecto Salud clinic’s staff are bilingual (Spanish/English). Nevertheless, Dr. Palacios notes that a growing number of patients they see are natives of African countries.

Anyone without health coverage can ask for an appointment at Proyecto Salud. Usually a patient will be asked to pay an amount that varies depending on income. The typical price will range from $20 to $35, although the visit might be free if the patient has no means to cover it.

Regarding further treatment, Proyecto Salud tries to provide very affordable medications to its patients. Most of the time, they only pay a $5 administrative fee to get them.

Diabetes School

Between 450 and 500 patients registered with Proyecto Salud suffer from diabetes, mainly type II diabetes which onsets in adults. Because diabetes is more common among Hispanics and African Americans, Proyecto Salud offers the Diabetes School, a three or four sessions special program for diabetes patients, in addition to doctor’s visits and regular blood tests.

"The focus is how to help the patient to manage what he can manage," said Dr. Palacios. Patients take a diagnostic test to know how well informed they are, then they are trained about diverse aspects of diabetes and they are advised to come to their regular medical visits to check their blood sugar levels, and to check their glucose levels using a tool the clinic provides them. Also, Proyecto Salud has partnered with Suburban Hospital for some years now to help diabetics treat the complications of diabetes.

Financial Support

Proyecto Salud has a budget of one million dollars. Fifty percent of it comes from Montgomery County, another 10% is provided by the US Department of Health and Human Services (HHS), and 25% comes from payments from patients. The rest (15%) is covered by donations.

Related Articles

Montgomery Cares…for the Uninsured
http://www.omhrc.gov/templates/content.aspx?ID=4949&lvl=2&lvlID=113

Links

Primary Care Coalition of Montgomery County
http://www.primarycarecoalition.org/index.php?parent_id=6

http://www.openhre.org/local/UG06/PCC.pdf

Montgomery County Department of Health and Human Services
http://www.montgomerycountymd.gov/hhstmpl.asp?url=/content/hhs/index.asp

Blueprint for Latino Health in Montgomery County, MD:
Executive Summary (PDF) or (HTML)
Complete Report (PDF) or (HTML)
Report in Spanish (PDF) or (HTML)

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Sandra Bechan was a writer for the OMHRC. Comments? Email: Sandra Bechan.