The Outpatient is In

A New Harlem Clinic May Be a Litmus Test for the Future of City Health Care

The beauty of the arrangement is that, like all the care HHC provides, this quintessentially modern, consumer-oriented approach is bestowed on the insured and uninsured alike. ''We focus on all of our patients as if they're in managed care,'' says Audrey Weston, an associate executive director at HHC's North Manhattan Network.

HHC's odds in the growing competition for medicaid recipients--and their revenue--may be improved by the loyalties of such patients. Austin Iles, who's waiting at Ron Brown for a rheumatology appointment, could go elsewhere for care. He's covered by medicaid and has traveled to Presbyterian on occasion. But he says he's felt more at home in the public hospitals for years, ever since he went to a private doctor who wouldn't accept medicaid and referred him back to Harlem Hospital for help. ''I'm happier here,'' says Iles.

Like every patient at Ron Brown, Iles has been assigned a regular physician. And all the doctors at the center, many of whom live in the neighborhood, have admitting privileges to Harlem Hospital. ''Patients get to see their own doctors in both the hospitals and the clinics, so the care isn't fragmented,'' says Renaissance's chief operating officer, Gayle Lewis, who was also closely involved in launching Ron Brown.

No doubt Lewis was chosen to get the Ron Brown center off the ground because of her long history with Renaissance, which she has guided through its growth and struggles. She may have similar success with her latest project. Clearly the doctors, nurses, and patients who greet her warmly as she passes through various waiting rooms are on her side. Unfortunately, stiff competition in health care and the city's fiscal austerity are not.

This is the last of three articles on the status of public health care in the city.

Harlem's health

Mayor Giuliani recently complained that public hospitals have become ''job centers.'' But as he--and the city's Health and Hospitals Corporation--complain of the bloat in the system, vital statistics may speak louder than empty hospital beds when it comes to the health needs of a community.

Pointing to the police department, which hasn't been asked to ''rightsize'' due to the drop in crime, public-health advocates argue that any excess in the city's health budget could be well spent on prevention. Harlem, a federally designated ''medically needy'' area, will no doubt benefit from the preventive services at the new Ron Brown center, including nutrition, family planning, and sickle-cell treatment. But, as the following look at some of the community's vital signs shows, Harlemites still have a long way to go for health equity.Infant mortality: The number of babies who live through birth is seen as one of the best gauges of a community's overall health. Central Harlem has had the highest infant-mortality rate in the city since the health department began keeping statistics in 1950. While most infant deaths are thought to be avoidable with appropriate prenatal care, more than 15 of every 1000 infants die, making Harlem's infant mortality rate almost twice that of the city as a whole.

Cancer: The death rate from cancer in Central Harlem is also the highest in the city. Cancer, much of which is associated with diet, smoking, and toxins in the environment, causes almost 300 of every 100,000 deaths in the community, compared to less than 200 citywide and 129 across the country. HIV/AIDS: AIDS is now the number one cause of death for both men and women between 25 and 44 in Harlem. With more than 179 of every 100,000 people dying of AIDS in Central Harlem in 1996 (the most recent year for which statistics are available), the neighborhood's AIDS mortality rate is almost 15 times the national average and more than two and a half times the city average.

Overall life expectancy: Considering the collective effects of Harlem's many epidemics, researchers in 1990 figured that a man in Bangladesh had a better chance of making it to 65 than his counterpart in Harlem. A more recent study came to the grim conclusion that a 15-year-old boy in Harlem has a 37 per cent chance of living until age 65. For girls, the chance is 65 per cent.

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