The Philadelphia Department of Public Health has proposed - and Mayor Nutter appears likely to include in his budget presentation tomorrow - new fees on a sliding scale for patients without health insurance.
With a budget gap looming and the clinics already stretched, however, how can the Health Department afford not to charge everyone at least something?
Officials say that the clinics have been free because most of their patients, even those with insurance, have little money. But they concede that the practice of not collecting co-pays must be revisited.
"Once you begin to charge one group, you need to look at how you charge every group," said Tom Storey, director of ambulatory health services, as the clinics are known internally.
Health Commissioner Donald F. Schwarz's proposal on fees, posted on the mayor's budget Web site, calls for "new sliding-scale fees for uninsured," with estimated revenue of just over $1 million.
"Rather than going after poor people," said Cathy Scott, president of District Council 47 of the American Federation of State, County, and Municipal Employees, "we think there are lots of other ways that the Health Department could save money."
Scott, whose union represents nurses and other professionals in the health centers, said that well before the uninsured proposal came up, she suggested to Schwarz that co-pays be collected from those who have insurance but that he was noncommittal.
About a fifth of the annual 334,000 patient visits are covered by private insurance or Medicare, so the union estimated that even if co-pays averaged as little as $10, the city would raise about $700,000 - a tiny amount compared to its other suggestions, but still a net positive.
In an interview last night, Schwarz said that part of his proposal, about improved collection of reimbursements, does call for charging co-pays for people with insurance. "We are required by contract to collect them," he said.
