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Commentary: Can more people get health care without more providers?

Patients don't normally embrace their dentists after getting a tooth pulled, and dentists rarely reward patients with a crisp $5 bill. But this was no ordinary day in Gallatin County, population about 6,500, deep in the hills of southern Illinois on the banks of the Ohio.

A tyke with a toothache so painful he could not focus on learning became the first customer for a dental clinic debuting in a school-based health complex. After the dentist performed the extraction, the boy hugged him, a clinic worker recalls.

"Dr. Settle asked him if he wanted to keep the tooth. He asked 'what for?' The little guy did not even know about the Tooth Fairy. Dr. Settle reached in his pocket and gave the little guy $5 for it."

Savor the poignancy of that moment. Applaud the General Assembly and Gov. Pat Quinn for enacting legislation that soon should allay periodic staffing problems in Gallatin County and elsewhere by allowing dentists to volunteer their services at state-funded clinics without immersion into the Medicaid program. But also understand the daunting challenges in sectors of Illinois - both rural and urban - where a plethora of poverty and a paucity of medical, dental and mental health professionals combine to deny timely treatment even to some covered by public or private insurance.

Coverage does not guarantee access - an often overlooked reality that merits far more focus as we contemplate an estimated 1.4 million of currently uninsured Illinoisans boosting demand as federal health-care reform unfolds.

Although most of our communities are not yet experiencing a primary care crunch, the Kaiser Family Foundation suggests that Illinois still has a greater need for family practice physicians than 39 other states, ranks 36th in availability of dentists and stands 28th in access to mental health professionals.

Kaiser's survey also indicates a dearth of nurse practitioners, seen by state officials as critical components in expanding primary care. Illinois has only 29 per 100,000 residents, compared to the national average of 51, presumably because we limit them more strictly, and our physicians wield more clout.

Should physicians ease their opposition to further empowering the nurse practitioners? Should the nurses yield ground to certified nursing assistants? Should dentists permit hygienists to operate more independently?

Clearly, professions and policymakers must separate compelling physical and mental health considerations from turf protection for our state to handle the surging demand. Moreover, we need teamwork and effective communication to deliver integrated, coordinated care for individual patients and to fully utilize the skills and training of every potential provider.

Julie Hamos, the new director of the Illinois Department of Healthcare and Family Services, stresses that the anticipated addition of between 600,000 and 700,000 recipients to the state's Medicaid rolls underscores the urgency of augmenting the health-care network wisely and efficiently. Indeed, all of us have a stake in this - as patients, as taxpayers, as Illinoisans.

We need policies and initiatives to entice and retain professionals. That includes malpractice reform. It requires adequately compensating physicians, dentists and other professionals who serve the poor. It could involve debt relief or other incentives for medical school graduates who agree to practice in chronically underserved communities and regions. We also need to expand and refine our telemedicine capability and to bolster clinics delivering primary care to people who otherwise would have difficulty obtaining it.

Even if we succeed, few patients will receive $5 bills from those treating them. But we will have demonstrated a commitment to common cause worthy of a state that so closely links itself with the man whose face graces that currency.

Mike Lawrence, former reporter, press secretary for then-Gov. Jim Edgar and director of the Paul Simon Public Policy Institute at Southern Illinois University, is retired. He writes a twice-monthly column.

This article first appeared in the St. Louis Beacon.

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