Neighborhood Health Centers Offer Cheap, Accessible Care

Nearly 30,000 Cantabrigians found an alternative to expensive and unfamiliar health care in nine city-run neighborhood health clinics last year.

Catering to low-income, non-English speaking, and other nearby residents, the clinics provide an affordable option to private physicians and large hospitals which doctors and administrators say is responsible for their success.

"When you have a piece of [the health care] system sitting right in the neighborhood, it's a lot easier than finding a doctor in the phone book," says Richard de Filippi, a member of the Cambridge Health Policy Board.

Doctors also take pride in the local base of each clinic. Dr. Michael B. Bader, a resident at Cambridge Hospital who spends one day a week at the Riverside clinic, says "I like to bring medicine out of the hospital and into the community."

Three of the clinics, located in elementary schools, offer medical services to children who do not have access to more traditional health care, says Joan Zoroff, director of ambulatory services at the hospital.

Having the centers in the schools where they also perform the role of the traditional school nurse--makes it easy for doctors and nurses to monitor the children's health as they grow up. "We have cared for (many children) since infancy," says Peggy Burns who has been a registered nurse at the Martin Luther King School facility since its founding 14 years ago. She says she gets very close to the children and their families and has even had the opportunity to treat the children of former patients.

In the adult and family clinics, scattered across the city and servicing health needs ranging from gynecology to nutrition, similar close relationships develop between doctors and patients. Patients have been known to follow a doctor or nurse practitioner across Cambridge when he or she transfers to another clinic or practice "You really get to know people," says Helen Cappello, a nurse practitioner, adding that she has "patients that I wouldn't hesitate calling it they missed an appointment."

Special Services

One special service of the clines is bilingual treatment Cambridge has large Spanish Portuguese and French speaking populations, consequently the hospital tries to hire bilingual staff members and recruit interpreters. The city also pays for language lessons for doctors and nurses who take courses.

"In a varied town like Cambridge where there are a variety of socioeconomic groups, it is a great benefit for people to go to a place where someone speaks their language," says Edna Homa, chairman of the Cambridge Health Policy Board.

In addition to serving the non English speaking community, many of the centers customers come from low income families--three of them are affiliated with public housing--who are charged on a sliding scale based on their annual income.

Because the clinies serve a large number of poor people administrators say they are constantly having to battle the image that there is a stigma attached to using the facilities. "People seem to think that clines have this poor people mentality and that you don't get to see the same doctor or nurse every time you go. That is the image we're lighting," Zotoff says.

"In the past that [low income residents] has been the population that came to us, but I think we are trying to reach out to more people," says Michael J Ryan, a hospital administrator.

He emphasizes that the clinics are open to anyone and that their rates competitive with private, profit making facilities and he points out that if more people able to pay for their care used the clinics it would keep prices down and insure their survival by decreasing the burden on the city. The clinics now operate with a $929,000 budget, with an average cost of $30 per visit.

Ryan is currently serving on a committee appointed by the city manager to study the centers and their future. The panel is considering the possible effects of leaving the system intact, expanding it to serve new constitution, or streamlining it by consolidating programs. Citizens will have the opportunity to respond to the study which will be release late this fall and proposed changes in January during a series of community meetings.

But one thing is certain, despite rising costs, increasing competition, and changing patient populations