Staying healthy during hard times: the impact of economic distress on accessing care and chronic disease management.

Thomas P. O’Toole, MD, Lauren Buckel, MPH, Stephen Redihan, BS, Stacey DeOrsey, MSW, and Daniel Sullivan, MSW  the reCeNt eCoNomIC dowNturN aNd limited “jobless recovery” has placed an increasing number of individuals at-financial risk. In Rhode Island the unemployment rate has consistently ranked among the highest in the country, exceeding 12% throughout much of the recession. The loss of jobs coupled with the out-migration of younger workers to more areas with more robust economies has concentrated need among those remaining while at the same time reducing the tax base and resources available to assist them. What is less well known is how medical costs are considered during economic downturns and in the context of other competing basic needs, particularly when those costs are “fixed” and health care or medications are considered less urgently. Medical debts are the second most common cause of personal bankruptcy and cost has a direct effect on where and when an individual seeks care. In this paper we report on data from the “Making Ends Meet” initiative at the Providence Veterans Administration Medical Center which was launched in November, 2008. Patients at the VA who self-identified in response to posted fliers within the hospital as being affected by current economic conditions were asked to completed a survey and meet with a social worker. They initially had a telephone screening and received an information packet of available VA and community resources. All respondents were then offered assistance navigating the care system, pursuing food, housing and utility assistance programs, and stress-management counseling through scheduled group and individual sessions with the social work staff. Our findings help define the role hospitals play as part of the safety net during recessionary periods.