Cooperative care

By: Angelica Herrera Azher Quader, a 62-year-old urologist from India, spends one Sunday a month volunteering as a medical consultant at the Muslim Community Center in the North-west Side’s Albany Park neighborhood. He estimates that 90 percent of the people he sees at the center’s health screening sessions have no health insurance or a primary-care physician to follow up with. And it can take them months to get an appointment at a clinic offering free or reduced-price services.

According to the U.S. Census Bureau, about 1.8 million Illinoisans also lacked insurance in 2004, the latest year for which the figures are available. Nationwide, the number has been rising steadily by an average of more than 1 million a year.

The experience led Quader to search for ways to better treat his patients. “I felt like something needed to change,” he says. “It’s important for patients to have some continuity of care.”

His answer was not opening another neighborhood clinic. Instead, he devised a system to link physicians who would agree to take on patients at a discounted rate. Quader says having such a “network” of doctors helps keep the operating cost at a minimum while benefiting both parties involved.

For doctors, the system allows them to work out of their own offices and, depending on their workloads, decide how many patients they can afford to take on. They can also avoid dealing with insurance companies since patients are required to pay them directly.

For patients, the system means a drastic reduction in doctors’ fees. To take advantage of the system, they pay a six-month membership fee of $30, or $60 per family, and $25 each time they see a doctor. They also have access to discounted laboratory and x-ray services.

Since 2004, more than 250 patients have joined the system, which Quader named the Compassionate Care Network. He has managed to recruit 70 physicians, who operate out of 24 offices in the Chicago area. And, when patients require blood work or x-rays, they have access to six labs and 12 imaging centers.

Recently, Quader sat down with The Chicago Reporter to talk about his experiences.

What was your motivation to start the network?
I’ve been in the practice for about 30 years. And, having seen the medical practice in a small town in Troy, Ohio, I saw that, in bigger cities, we have a lot more people who are uninsured and are not being taken care of. I think that was the reason I felt like something needed to change.

Who is using your services?
They are people who are working poor. They have jobs but they don’t have the ability to afford the premiums that their insurance is asking. Or that they’re not in a big corporation where a program was available for them to join.

Most of them are from Indian and Asian backgrounds. And there are also a lot of Hispanics and African Americans. We have a variety of people. We also have patients who are undocumented. These undocumented don’t want to go to government agencies; they don’t want to go to clinics because there’s a potential that someone there will be asking them questions about their residence and identity. The city and county have clinics, but the problem is that they’re mostly on the South Side, which is where the need was originally. Now the need has changed because of the demographics.

It’s not surprising that the undocumented are uninsured. They are basically the ones working in cleaning our buildings, mowing our lawns and don’t usually have a corporate entity to connect with. I think they would say that, as long as they’re healthy, they will stay healthy. When they fall sick, then the issue comes up. It is the optimism of the people that they feel like they won’t fall sick, but an accident can take place at any time.

What’s the impact on society of having so many uninsured people?
Big. It’s a huge financial burden on people because we are paying for it in one way or another. People who don’t have any insurance are the people who are going to be using emergency service, which is the most expensive kind of care. Once they’re taken care of at emergency rooms, they’re thrown back out into the streets and inevitably fall back into the same cycle. I think, if we can somehow take care of these patients before they fall sick, it makes more sense because we can avoid those expenses. A normal stay of a week or 10 days in a hospital will cost $100,000. That is the financial burden and financial implications on society we’re talking about. Unfortunately, we don’t pay enough attention to the preventative side of medicine. If we don’t start paying attention, this cycle will never change.

What’s your view of our health care system? What needs to change?
The health care system in our country is pretty messed up. Each physician is allowed to create their own structure according to what they feel is the appropriate one. Each insurance company pays [physicians] differently for the same services, but the patient doesn’t care because they’re not paying; insurance companies are paying. That’s where I think the problem is---once you’ve taken away that relationship between who is paying for the service and who’s receiving, the market forces we think are supposed to work don’t work anymore. The patient is totally out of the picture. To change, it needs to become more market-oriented. I think these services need to be priced according to the market forces. I do think that physicians who obviously do a better job need to be reimbursed on a higher level for their expertise and their knowledge. Beyond that, the physician population needs to become aware of the expense side of medicine and try to, somehow, act in a way that the patient gets some benefit out of this system. Also the system needs to deliver care more efficiently. Bottom line, it doesn’t have to be as expensive as it is. We’re supposed to have the best care in the medical world, but what good is it if we continuously ask why 45 million people in our country don’t have access to our wonderful care?

What we’re trying to do in our small little world is to see if it makes sense. I think there’s a lot of potential here for people who have like-minded interests to pitch in and help out. If we had about 500 physicians who are willing to do this kind of work, and each one of them takes maybe 20 patients each year, we can take care of 10,000 more of the uninsured.

Should the government be responsible for providing medical services?
National health care, like they do in Canada and the United Kingdom, is not going to be a reality in our country. Our country is different. Our country is based on individualism, and I think that kind of mentality has helped guide us.

What are your thoughts on ways to control the rising costs of health care?
There are ways to control it, such as using generic prescription drugs and pricing it fairly. When you look at the money that is made by the pharmaceutical industry, or companies like Walgreen’s or Osco, they make their money in the area of the generic drug---never in the brand name. Say, for instance, a drug might cost 50 cents for physicians to purchase. Walgreen’s or Osco might sell it for like $10, while the brand name for that same drug costs $20. The patient gets to see the picture that he’s saving from $20 to $10 by going generic, but they don’t see that the company is still making that profit from 50 cents to $10. Whereas physicians have the capacity to purchase the drug for 50 cents and sell it for a dollar---and still make a 50 percent to a 100 percent profit. Doctors need to get involved in this process and not leave it up to Walgreen’s or Osco to take care of it. We need to explore these measures and we need to utilize them because, if we don’t, the costs won’t come down.

Also, if someone comes to us with a headache, we’re going to wind up doing all sorts of investigations to rule out possibilities because of the liability. My clinical judgment would say that it’s something minor, but my professional liability judgment would tell me that, if I don’t look into all of the possibilities, then I’m liable. All of us have an impact on the effects of health care. While all the political debates are going on, what we as individual practitioners can do is what we need to focus on. What that means is taking part in preventative care at the community levels, becoming part of health screenings and connecting patients with physicians who can take care of them and prevent them from a trip to the emergency room.