Magazine article Medical Economics

Physicians in California Fight Rural Health Clinics

Magazine article Medical Economics

Physicians in California Fight Rural Health Clinics

Article excerpt

John Mevi, a longtime family practitioner in the city of Los Banos in California's Merced County, the federal safety-net scheme known as the rural health clinics program represents unfair competition, pure and simple. A soloist, Mevi receives $16.81 for seeing a Medi-Cal patient. The hospitalowned clinic across the street, an RHC, can charge $125.

"The clinic is 20 yards from my office, yet it receives a considerably better fee than I do," he says. "It's a significant difference, and hard to explain."

On the other side of Merced County, an agriculturally rich area east of San Jose, pediatrician Edward Feehan has been trying to explain how localities haphazardly designated "medical-shortage areas" have been able to profit. An activist, Feehan self-published a book on the shortage-area designation process in 1994, and sent it to Washington. He's even gone so far as to quit the California Medical Association to protest its passivity on the issue.

"He's gutsy to be so outspoken, because he can't be making friends out of this," says Marcia Sayer, a staff member of the House Subcommittee on Human Resources, which reviewed Feehan's finding for background information.

Feehan's crusade against federally subsidized health care in Merced County eventually paid off. After visits by national media and federal inspectors, all but one of the county's shortage designations were removed.

"We were getting buried here," says Feehan. "We had subsidized competition all around us. The shortage designation areas and federally subsidized clinics of one kind or another were being milked to the hilt."

Like Mevi, Feehan grew alarmed at the number of hospital-based RHCs that were being established in the county, even though the area had become less and less rural. As a pediatrician with more than three-quarters of his patients on welfare, Feehan says his practice was "decimated" by the competition from pediatricians who contracted with the clinics. …

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