At Health Center 10, a Philadelphia-run primary care clinic, few options for uninsured patients

At Health Center 10, the only city-run primary care clinic in Northeast Philadelphia, people wait up to a year to get an appointment.

It’s easy to see why, stepping into the modest office building on Cottman Avenue: demand at this low-cost clinic is so high that every square foot has been optimized for the space. Narrow hallways are lined with lockers and cubicles that double as clinic rooms. Exam rooms aren’t much bigger than closets. The massive front desk has nearly a dozen staff who constantly answer ringing phones.

Uninsured and underinsured people have few options for obtaining primary care in the Northeast, where demand far exceeds the city’s ability to provide such care. Wait times for appointments at Health Center 10 are the longest in the city. The health department recently announced plans to open two new clinics in the neighborhood, but the first won’t open until at least 2025.

“This health center is packed,” said Yelena Galkin, medical director of the city’s ambulatory health services. “There is no corner where we can put extra staff to serve people. We do everything we can. »

Seeing a doctor regularly is essential to prevent and treat health problems that can escalate into serious chronic diseases. But for those without insurance or the “underinsured” who still struggle to pay health care bills, primary care is often unaffordable or inaccessible. Health Center 10 and other city-run clinics, which accept all patients regardless of insurance status or ability to pay, aim to fill these gaps.

Eliane Da Silva of North Philly posed for a portrait at the City Department of Public Health, Health Center 10 in Philadelphia.. … Read MoreMonica Herndon/Staff Photographer

“It takes forever to be seen,” said Eliane Da Silva, 57, a North Philadelphia resident who doesn’t have health insurance, speaking in Portuguese through a department translator. of health.

Once after an appointment, she says, her doctor asked her to return two weeks later for follow-up care. But the first date Da Silva was able to get was months later.

Increase in inequalities

Poverty rates have increased over the past 30 years in Northeast Philadelphia, where some 425,000 people live. In Mayfair, the neighborhood immediately adjacent to Health Center 10, the number of residents living in poverty jumped 420% between 1990 and 2017. The neighborhood has one of the highest rates of uninsured patients in the city, said Cheryl Bettigole, City. health commissioner.

It’s also home to the highest concentration of people migrating to Philadelphia, said Bettigole, who ran Health Center 10 before becoming the city’s top public health officer. By law, immigrants cannot get government-funded Medicaid medical coverage for five years after getting a green card. Until then, many cannot afford private insurance and rely on Health Center 10 for care.

“It’s an incredibly diverse and vibrant part of town, but it doesn’t have access to healthcare,” Bettigole said.

Patients at city-run health centers pay on a sliding scale if they don’t have insurance, which Bettigole said typically costs between $5 and $20 per visit. About 40% of patients at Health Center 10 are uninsured.

Besides primary care, the clinics offer dental care, pediatric primary care, women’s health care, vaccinations, and testing for sexually transmitted diseases, tuberculosis, and other conditions. There is also a pharmacy on site. The idea is to provide patients with a one-stop-shop for primary care needs.

Typically, new patients are offered an appointment within nine months, Galkin said; returning patients typically get an appointment within six hours. Staff leave some slots open for urgent care, but high demand and understaffing make it difficult to provide prompt service. Across the city-run clinic system, about 30% of staff positions are unfilled, said Chanel Conley-Bacon, director of operations for Health Center 10.

“It takes forever to be seen”

Patients receiving care at Health Center 10 have said they appreciate many of the services it offers. But because the demand is so high, they also have to wait much longer for care than someone with private insurance. And many patients here simply have no other option.

On a recent weekday afternoon, Tajkera Perdous sat in the waiting room at Health Center 10, helping her mother to an appointment. A former patient herself, she explained that she liked the care she personally received at the clinic, but chose to find a doctor elsewhere when she could.

Tajkera Perdous speaks with a reporter at the City Department of Public Health, Health Center 10 in Philadelphia, Pa., Tuesday, May 23, 2023. Primary care services are available at Health Center 10, including dental care.. .. Read MoreMonica Herndon/Staff Photographer

“They don’t do anything on time – that’s the main problem,” said Perdous, 23, whose family is originally from Bangladesh but has lived in Parkwood for 10 years.

Recently, her brother-in-law, who is uninsured, moved to town and tried to make an appointment. He was given a date in a year.

Across the room, a line of patients waited to see the in-house pharmacist. Downstairs, the pediatric waiting room was crowded with parents and children. The clinic sees around 300 to 400 patients a day, and its regular patients speak 40 languages ​​among themselves. Some translators work at the center, but other patients have to call a telephone translation service during appointments.

Speaking in Portuguese through a translator, Da Silva spoke enthusiastically about her primary care doctor at Health Center 10, but said she did not always receive adequate or humane care. from other clinic staff. Because she’s uninsured, she said she couldn’t go anywhere else.

She remembers leaving in tears after a difficult appointment during which she felt belittled and mistreated by a doctor. But she didn’t know who to tell about the experience and felt like she had no choice but to be treated elsewhere. (Asked about the incident, clinic directors said they were investigating and declined further comment. In a statement, health department spokesman Jim Kyle said the department is “taking these types of complaints very seriously and strives to maintain a welcoming and safe environment for all patients.”

In the pediatric unit, a young mother who also speaks Portuguese arrived with her son for his first appointment at the clinic. She had requested the appointment in October – seven months ago.

The woman had resigned herself to the long wait, she told health department translator Yorhanna Costa. “It’s a different country,” says the patient. “I think it could be like that here.”

Bettigole said it was crucial for the city to provide more primary care for its most vulnerable residents. A 12-year veteran of the city’s health centers, she recalls treating middle-aged patients whose life expectancies were “significantly shortened” because they were unable to pay their bills. health problems earlier.

“If I had seen them at 30, we could have put them on medication that cost pennies a month,” she said. “It’s devastating to communities – and it’s completely preventable.”

A sign reads “The whole world is understaffed; be kind to those who show up,” in the reception area of ​​the City Department of Public Health, Health Center 10 in Philadelphia.. … Read MoreMonica Herndon/Staff Photographer

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