For two decades, Chinatown Clinic of Saint Vincents Hospital and Medical Center has served the uninsured and underinsured residents of the Asian-American community on Manhattan's Lower East Side.
But times are changing, and the clinic's pre-eminent position could be challenged by competition from other New York providers.
Siu Ching Mok, Chinatown Clinic's nursing manager, said the number of patients has not yet declined as a result of competition from other clinics serving the Asian immigrant population. But she views 1996 as a year during which the clinic will have to strengthen its services to keep the patients it now treats.
"Our hope is that the clinic will continue to go further in helping this population," Mok said. "The problem is that with all of the changes happening in healthcare, people are opening clinics all over the place. There's a lot of competition, and we are overwhelmed by the number of patients already."
In 1995, about 25,000 patients visited Saint Vincents Chinatown Clinic, which has a staff of 22 physicians, nurses and a social worker. The number of patients has increased steadily every year since 1976, when 2,000 patients came to the clinic.
Saint Vincents Hospital, located on Manhattan's West Side, won't disclose financial details of the clinic's operations. A spokeswoman said the hospital subsidizes 15% to 20% of the clinic's costs.
That's not surprising, given the patient population. According to the 1990 U.S. Census, there are about 22,000 people living in Chinatown. Nearly 15% of those people receive Medicaid benefits.
At the clinic, 80% of the pediatric patients are covered by Medicaid and 95% of expectant mothers receive benefits through a New York state program for prenatal care.
Whether the Saint Vincents clinic will continue as the major provider for the community is in question. Already there are clinics designed specifically for the Chinese in other boroughs of New York.
For example, Victory Memorial Hospital's Family Health Center in Brooklyn serves the new Chinese immigrant population in Brooklyn's Little Chinatown. St. Joseph's Hospital in Queens, part of Catholic Medical Center of Brooklyn and Queens, offers an outpatient program geared toward serving the Korean population. It also recently developed a Queens Breast Health Partnership run by the American Cancer Society, which offers free gynecological services at the clinic for Chinese women.
A more local competitor for the Chinatown Clinic could emerge in 1996 through Beth Israel Medical Center in Manhattan. Peter Kelly, Beth Israel's chief operating officer, said a large number of Chinese patients are treated at the Petrie division of the Beth Israel system located on the Lower East Side near Chinatown.
There are more than 30 Chinese physicians on the Beth Israel staff who practice in Chinatown, offering healthcare to both insured and noninsured patients.
Kelly added that there are ongoing discussions with these physicians about how to best serve the Asian population, and that while nothing is definite, plans to build a freestanding health facility in Chinatown "are not out of the realm of possibility."
Educational and preventive programs at Saint Vincents Chinatown Clinic are partially funded through patient fees. Jayne Greene, a spokeswoman for Saint Vincents, said the hospital provides advertising and promotes health fairs that attract more patients to the clinic.
Convenience and, more importantly, quality of healthcare are the factors that will determine the ability of Saint Vincents Chinatown Clinic to continue to increase its patients, Mok said. For Chinese immigrants who live in Brooklyn, a 40-minute commute to the Chinatown clinic would not make sense when there is a clinic near them. So keeping the local patients coming is the clinic's biggest concern.
"I am worried that the patients will go elsewhere," Mok said. "Sometime this year we are going to see the effect of the competition. We always maintain the quality of services here, because by providing quality care, patients may come back."
Services provided at the Chinatown Clinic include obstetrics, gynecology, pediatrics and adult medicine. The clinic also has a parent education program in which new immigrants are taught the laws of the United States that are applicable to child rearing.
Most of the patients who visit the clinic have no medical insurance. Mary Ann Lee, a pediatrician at the Chinatown Clinic, said that some of the patients have insurance through the garment workers' union or through Medicaid, but that most of them are now used to getting primary healthcare.
The clinic charges low fees of about $30 to $48 for most services. Language presents a barrier for many patients, who would not feel comfortable trying to acquire healthcare services at a hospital where Cantonese and Mandarin are not spoken and where medical insurance is required. Eighteen of the staff's 22 members speak Cantonese and Mandarin, and according to Lee, all of the staff members understand the cultural beliefs of the population they serve.
"The Chinese population has a very different belief system from mainstream America," Lee said. "Medical decisions are family-oriented rather than just individual, and religiously, they believe that what comes around goes around. Doctors have to understand why certain people refuse treatment, and this could be very frustrating to providers who are not familiar with the culture."
"We saw a need for a clinic like this in 1976, when no one paid attention to the healthcare needs of this community," Mok said. "That need hasn't changed up until today."