RAM: Bridging the Gap in American Healthcare
How do isolated, underserved, and impoverished people living in the U.S. receive access to healthcare services? Many don’t; a report by the United States Census Bureau showed that in the year 2010, only 12% of all uninsured adults went for routine health check-ups . A 2003 study by the National Academy of Sciences found that uninsured Americans also use less healthcare on average than their insured counterparts . Why is this the case? The study found that the cost of care for those who are uninsured with often lower incomes is disproportionately greater than those who are insured and have higher incomes . If the uninsured are less likely to go to a healthcare provider, why not provide healthcare directly to them? If the impoverished experience higher out-of-pocket expenditures and financial stress for healthcare services, why not provide free care? If this sounds too good to be true, thankfully it’s not.
A non-profit organization called Remote Area Medical (RAM) is changing the landscape of healthcare by going to the heart of isolated, underserved, and impoverished communities in the U.S. . And better yet, they are providing healthcare services at no cost to those they serve . In 2016 alone, RAM provided a total of 30,000 people with basic dental, vision, medical, as well as education for preventative healthcare, absolutely free of charge . Since 1985, RAM has supplied $112 million worth of healthcare services at free mobile clinics that span nationwide . How does RAM do it? They rely entirely on humanitarian donations and the volunteer effort of local physicians, nurses, and good Samaritans within the community they serve. That’s where my experience comes in.
Last fall, I went to a RAM mobile clinic as a student volunteer in Elkview, West Virginia. In the long halls of a local middle school, at the site of the mobile clinic, stood rows upon rows of people seeking healthcare services for the first time, or as the place for their annual check-up. I remember waking up early in the morning and heading over to the clinic before the sun came up, but already waiting in line hours beforehand were people from the community seeking treatment. As the day grew longer, so did the line, but the spirit of service never wavered.
By the end of the mobile clinic, just over $213,000 in medical services was provided to nearly 500 people . On average, that means after one weekend each person received $426 in free healthcare services, or $1,704 total for a family of four. For a family living at or below the poverty threshold in 2015, one weekend of medical services provided by RAM would be worth at least 7% of their annual household income. What’s the significance of RAM’s ability to cover a family’s household income toward potential medical expenditures? According to a report by the Organisation for Economic Co-operation and Development (OECD), the average share of final household consumption for out-of-pocket medical expenditures in the U.S. was 2.6% . That means that during my time with RAM, up to 125 families - who would not have access to healthcare services otherwise - were able to have three times as much as the average U.S. household spends on medical expenditures.
Beyond the numbers, RAM’s mission does so much more. In my short experience as a RAM volunteer, I saw both a 25-year-old and 65-year-old visit the dentist for the first time, and I saw a mother get her first pair of glasses since her son ten-year-old son was born. Each person that comes to a RAM free mobile clinic walks away with much more than the tangible; they leave with the ability to see clearly again, to eat without pain, to smile with confidence, or to feel compassionately cared for.
Free mobile clinics like RAM are more important now than ever. In 2008, an annual RAM clinic in Knoxville, Tennessee became the center of a story for 60 Minutes, titled “Lifeline” . The episode has been attributed to not only exposing the massive humanitarian efforts that RAM relies on, but also the “cracks” in America’s healthcare system . Nine years after the episode, the cracks have expanded into well-defined gaps that still afflict the nation at large.
What’s the gap in American healthcare? The U.S. has the highest health expenditures per capita of any other nation in the world, but its life expectancy at birth and at age 65 is among one of the lowest, according to a 2015 health status report by OECD . Along with Greece, the U.S. is also one of the only 34 developed nations that does not achieve universal, or near universal, healthcare coverage for all of its citizens . Moreover, the U.S. has the largest proportion of unmet care needs, whether for medical or dental examinations - due to cost, waiting time, or traveling distance - compared to eleven other major developed nations . What is even more startling is the fact that individuals who make below average income have 25% higher unmet care needs than those making above average income; this is the greatest gap between income level and unmet care needs of any country measured in the OECD study .
Yet, it goes beyond adverse socioeconomic conditions, poor access to affordable healthcare providers, and unmet care needs. The American Hospital Association (AHA) found that a total of $538 billion in uncompensated care accumulated over the course of 2000-2016 in U.S. hospitals of all types . Uncompensated care is defined by the AHA as the total measure of expenses provided by hospitals to patients as either anticipated financial assistance or unexpected bad debt, which is not repaid by either the patient or the insurer . The upward trend of uncompensated care is equally as troubling as unmet care needs, because it is often a reflection of healthcare services used by those who are uninsured . In fact, it’s been shown that uncompensated care can give rise to higher local taxes, redirection of public funds from other important public programs, and less availability of other public services in communities in order to subsidize and reimburse the unpaid costs .
Despite the present gap in American healthcare, there’s hope for a better future in non-profit medical organizations like RAM; they are the bridges that traverse the murky divide between healthcare access, resources, and distribution. Yet bridges will not be enough to support our future. The life of our nation depends on affordable and accessible healthcare services for Americans across all plains of income and location. As my own experience with RAM taught me, the people waiting in lines for days to visit a doctor or dentist once every year, let alone the first time in 65 years, need and deserve more.
United States Census Bureau. (1 Oct. 2012). Americans Are Visiting the Doctor Less Frequently, Census Bureau Reports. Newsroom. Retrieved from https://www.census.gov/newsroom/releases/archives/health_care_insurance/cb12-185.html
Committee on the Consequences of Uninsurance. (2003). Hidden Costs, Value Lost: Uninsurance in America. National Academy of Sciences. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221653/
Remote Area Medical. (2017). Retrieved from https://ramusa.org/
OECD (2015), Health at a Glance, 2015: OECD Indicators, OECD Publishing, Paris. Retrieved from http://dx.doi.org/10.1787/health_glance-2015-en
American Hospital Association. (Dec. 2016). American Hospital Association Uncompensated Hospital Care Cost Fact Sheet. Retrieved from http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf