Project Description Narrative:
In Milwaukee County, it is estimated that over 50,000 people, or 9% of the population, are uninsured and do not have access to appropriate health care. Notably, three-quarters of Wisconsin’s uninsured population are eligible for health coverage through marketplace insurance, governmental, or charity care. This project seeks to address the surgical needs of this uninsured population, an important step towards improved health equity in Milwaukee. Currently, there is no formal or efficient pathway for all uninsured populations in Milwaukee to access surgical care.
If uninsured patients need surgical care, two inefficient and costly routes exist. Most commonly, patients are seen in the emergency room because they have no other means to access care. This can lead to hospital admission for a non-urgent, but potentially life-altering procedure. In addition, if a pre-operative work-up is required for a presumed diagnosis such as cancer, this must all occur while inpatient, leading to unnecessarily long lengths of stay, time away from work with lost wages, and a costly hospital bill. Alternatively, a patient’s disease may progress to an emergency, causing unnecessary morbidity for the patient and increased utilization of health care resources. A second mechanism for uninsured patients in Milwaukee to see a surgeon is through referral from a local free or charitable clinic. Informational interviews have revealed a process that is cumbersome and frustrating for both patients and clinicians. Primary care clinicians associated with free clinics in Milwaukee may refer an uninsured patient to Froedtert or other Milwaukee hospital systems for surgical evaluation; however, the patient must go through the process of obtaining health insurance coverage, hospital system charity care, Specialty Access for the Uninsured Program (SAUP), or a similar program.
Patients and staff often spend significant amounts of time obtaining coverage and approvals for specialty evaluation. While this arduous process benefits some patients, many are evaluated by the surgeon and found to have nonsurgical conditions or encounter other barriers during the evaluation process precluding surgery. This research will lead to the development of a referral program specific to surgical disease and the creation of a pathway by which uninsured patients can navigate the healthcare system to receive surgery.