DOCTORS LESS ABLE TO GIVE FREE CARE.

Byline: Brad Greenberg Staff Writer

As the number of Americans without health insurance climbs, physicians are less able to provide free medical care to the poor, a new study says.

The percentage of doctors who provide charity care has dropped from about 76 percent a decade ago to 68 percent last year - a decline attributed to increasing health care costs and smaller reimbursements from insurance companies and HMOs.

Doctors also are no longer able to subsidize poor patients by charging others more, according to the study to be released today by the Center for Studying Health System Change in Washington, D.C.

As a result, doctors are taking it in the wallet.

``You have a mortgage to pay, medical school loans to pay back, you have a car, a wife and family to support - you can't make it on charity care,'' said Dr. George Ma, a Chinatown internist who whose patients mostly are on Medi-Cal or are uninsured. ``You cannot have just poor patients unless you are independently wealthy.''

Dr. Samuel Fink, a Tarzana internist who is on the board of the Los Angeles County Medical Association, still finds the ability to discount services for needy patients and give them drug samples instead of sending them to the pharmacy.

But, he said, ``it is getting difficult for a lot of physicians to balance their time, their commitment to their patients and bring in the same profits.''

During the past five years, the number of uninsured Americans has increased from an estimated 39.6 million to 45.5 million. When physicians don't provide charity care, poor people end up in hospital emergency rooms or at tax-funded health clinics, of which there are about 50 throughout Los Angeles County.

Hospitals struggle with the burden because people often wait to turn up in the emergency room until after a minor problem has become a major cost. Caring for the ill in this way also is often a net loss for hospitals because they are not fully reimbursed for treating the uninsured.

Some have shut their doors and, during past three years, 408 hospital beds were lost with the closures of Granada Hills Community and the Sherman Way campus of Northridge Hospital Medical Center.

Valley Community Clinic in North Hollywood is a two-story medical building with primary care, women's health, dental and pediatrics, among other services. Patients pay on a sliding scale, based on ability. With 50,000 patient visits each year, the clinic is unable to take on new patients or walk-ins, said spokesman Evan Press.

The waiting rooms were generally full Wednesday evening with people like Manuel Vasquez, whose health insurance expired four months ago. The Van Nuys 18-year-old cares about his health and was on his first visit to the clinic to be tested for sexually transmitted diseases.

``It's good knowing there is somewhere you can go for free, where you can get checked on and they can tell you what's wrong with you,'' Vasquez said.

Free clinics aren't going away, but their resources will become further strained as fewer physicians can afford to provide charity care.

``The health care safety net is gradually falling apart,'' Fink said.

Brad A. Greenberg, [phone]

brad.greenberg(at)dailynews.com