If you ask Nina Vaccaro, the executive director of the Southside Coalition of Community Health Clinics, to describe the health landscape of South Los Angeles, she won't mince words.
"It's kind of a barren wasteland when it comes to specialty care and primary care providers," she said.
And there are a lot of reasons for that -- the challenge of providing affordable healthcare for all Americans is anything but simple. One issue, though, said Vaccaro, was that there was "a lack of a unified voice coming from the healthcare providers in the South L.A. region." That was the same region she said struggles with "historic underfunding with healthcare services." And that's how the Southside Coalition began: a network of eight federally-qualified health centers that serve the South L.A. region that work together rather than compete.
"[The clinics] felt it would behoove them to really work together instead of competing for some of the same limited resources in the area," she said. All eight clinics can be seen on the map below; the ones within OnCentral's area of coverage are St. John's Well Child and Family Center, South Central Family Health Center, Central City Community Health Center and UMMA Community Clinic.
View Southside Coalition of Community Health Centers in a larger map
"There just aren't enough resources," said Vaccaro. "We don't have enough specialists that serve even the insured population in South L.A." She pointed to a feasibility study the Southside Coalition did in 2005 and 2006 that found that the average wait time for uninsured patients to get access to specialty care was between six and nine months. That increased to 12 months when they focused on sub-specialty care and surgeries.
Vaccaro explained that South Los Angeles has one of the worst primary care providers-to-patient and specialty care providers-to-patient ratios. "There just aren't medical practices that want to service this community," she said. "Traditionally specialists and primary care providers don't make a lot of money off Medi-Cal," which is the California Medicaid program that services low-income families and patients.
She said that community health clinics are ideal places to work for doctors who want to work in South L.A.. But many of those doctors who don't want to work in the area consider it a safety issue. "[They ask], do I want to work in South L.A.? If I grew up, I lived in that community or in a very similar community, you may feel more comfortable working there, but if not, it's probably West L.A. or the San Fernando Valley that are a little more enticing."
Demand in the South L.A. area, said Vaccaro, simply "far exceeds" providers' capacity to provide care. "Part of the problem is you just don't have a presence of a hospital," she said, pointing to Martin Luther King, Jr.-Harbor Hospital's closure, St. Francis Medical Center's Lynwood location, California Hospital Medical Center ("which is basically downtown"). "You don't really have a place [in South L.A.] where physicians can practice," she added. Even the recently-opened Kaiser Permanente Facility on Manchester Avenue, she said, is a "pretty limited" facility.
The lack of a true, steady hospital presence underscores the importance of community health centers in the area, something U.S. Secretary of Health and Human Services Kathleen Sebelius emphasized in a press conference in downtown L.A. last month. But it also means that patients will be without a "medical home."
"'Medical home' is a new hot term in healthcare access across the country right now," explained Vaccaro. "The medical home really puts the patient at the center of their care. So instead of walking into a community clinic, not knowing what doctor you're going to see, not having a doctor you have a relationship with, you're looking at things like empanelment, where every doctor has a series of patients." In other words, patients would be assigned doctors -- and stick with that doctor, "as you would in private healthcare," Vaccaro said.
As far as the ever-present question of funding, Vaccaro called that "tricky." Historically, she explained, Los Angeles County has allocated dollars to community clinics through the Section 1115 Medicaid Waiver, the resulting funding for which is allocated by a given county to offset the cost of medical care for the uninsured in a given community. She said that's where South Los Angeles' historic underfunding started.
Statistics provided by L.A. Health Action indicate that from 2006-2007, 18.4 percent of South L.A.'s adult population had unmet medical need, but only eight percent of the county's funding went to that area -- not enough to meet its need. Compare that West L.A., which had close to zero patients with unmet need -- far less than South L.A. -- but received more .3 percent more funding than South L.A. did.
"We went through this issue where we said this is not OK," said Vaccaro. "We advocated on behalf of [South L.A.] and said we need to look at how we can be more equitable in this funding." Taking money from other service areas wasn't a solution, she said. There needed to be more funding.
In the end, South L.A. got more money and things improved -- but not by much, said Vaccaro. The South L.A. clinics ended up receiving a grant for $13 million that enabled them to expand and renovate their facilities, as well as provide more primary care services, but that funding was a one-time deal. "It's going away very soon, which means we'll be back to where we were in 2006, 2007."
And although health reform is on the horizon, southside clinics will still have a lot of work on their plate when it goes into effect. "We are constantly reminded that South L.A. is going to be left with one of the largest densities of people that are left without anything under health reform, because we've got a lot of undocumented individuals who, under health reform, are still not going to be eligible for anything," she said.
"South L.A. is a great place, and there are a lot of people here that have a lot of need," she continued. "We need to be able to provide healthcare services for everybody that lives here. It's a basic human right."