Dartmouth-Hitchcock Medical Center is widely touted as one of the premier healthcare complexes in New Hampshire and in the country. Despite DHMC's stellar reputation, though, and the comprehensive range of services it provides, a number of Upper Valley residents frequent a range of other healthcare centers in the area. Some provide unique reproductive and women's health-care, or services to the uninsured or others who cannot afford to pay for care.
The Good Neighbor Health Clinic in White River Junction provides basic medical services to Upper Valley residents who cannot afford care elsewhere.
"We always present ourselves as the place for people who have no other options," Clinic Executive Director Karen Woodbury said. Woodbury also heads the Red Logan Dental Clinic, an affiliated organization that serves a similar segment of the Upper Valley population.
The clinics provide free care to anyone at or below twice the federal poverty level, but encourages those on Medicaid or the Vermont Health Access Plan to pressure their insurance providers for the appropriate referrals, Woodbury said. The clinic serves few children, since both Vermont and New Hampshire's child healthcare plans cover most of those who need it, she added.
While the clinic provides a range of services, including alternative and homeopathic medicine and dietary counseling, it refers patients to DHMC and Alice Peck Day Hospital in Lebanon for more specialized care. With the clinic's referral, both hospital will provide care free of charge.
For some chronically ill patients, though, the clinic remains their primary care provider, Woodbury said.
The hospital also provides care to needy patients free of charge, absorbing the costs under its portion of the budget designated for charity, APD Director of Development and Community Relations Janet Thibideau said.
"We provide services to anyone who walks through the door whether they can afford it or not," she said.
The West Lebanon Branch of Planned Parenthood, which offers comprehensive reproductive health services, has a sliding fee scale designed to charge people based on their ability to pay.
But the clinic also serves patients with full insurance coverage, and patients come from all socioeconomic backgrounds, spokeswoman for Planned Parenthood of New England Vicki Jaffe said.
The sliding fee scale also applies to birth control bills and other prescription medication, which can run several hundred dollars a year without insurance coverage.
At the Good Neighbor clinic, patients receive medication through free samples or voucher programs worked out with area pharmacies, which have agreed to provide medications free of charge with a prescription from the clinic.
Long-term medication is provided through the nationwide Needy Meds program, through which the clinic's patients receive about $63,000 worth of medication annually from pharmaceutical companies, Woodbury said.
In addition to providing both homeopathic and traditional health care, the Good Neighbor clinic offers mental health services, since it found that many of its clientele were being turned away from other area mental health centers, Woodbury said.
Anonymity proves an important factor for many such patients, as it does for many women who seek services at Planned Parenthood.
"We do have a reputation for respecting patients' privacy," Jaffe said, but noted that the given quality of the care,
Planned Parenthood is in no way a clandestine, sub-par alternative.
Nevertheless, except for DHMC, Planned Parenthood's West Lebanon branch is the only abortion provider in the area -- and one of only a few in New Hampshire.
Some women who have been sexually assaulted seek medical help at Planned Parenthood, but a surprising number arrive at ADP's emergency room, which has an unusually high percentage of nurses specially trained to deal with sexual assault victims, Thibideau said.
Under the national SANE certification program, they are specially trained to collect evidence in sexual assault cases and to serve as expert witnesses in court.
Many of ADP's doctors and nurses -- as well as many medical students and medical personnel from DHMC -- also moonlight at the Good Neighbor clinic.
Since its staff is not paid, most of the clinic's $230,000 budget, which comes entirely from donations and fundraising drives, goes toward overheard and medications.
But ADP's primary advantage over DHMC, Thibideau said, is its small size.
Having just 82 beds means that surgical staff often remember the names of patients they operated on months earlier.
"DHMC is a tertiary care hospital," Thibideau said. "They provide care to very sick people -- very highly specialized care, but APD provides 97 percent of the care that anyone will ever need in their lifetime."
Meanwhile, at Planned Parenthood, although patients come from a range of socioeconomic backgrounds, nearly two-thirds are under 30, and over one-third are college-aged. Most come to the clinic for contraceptive counseling and services, Jaffe said.
Currently, there is little formal contact between Dartmouth students and health providers other than DHMC, Dartmouth Community Services Civic Intern Kyle Yamamoto said. Although many students volunteer or do research at the Dartmouth Medical School or DHMC, a lack of coordination has stymied efforts to students participate at other healthcare clinics.
"I would like to see a lot more initiative taken from both students and the organizations themselves," Yamamoto said. "I think the need is there and the interest is there."
