In today’s New York Times, Erik Eckholm reports on this nation’s crumbling and inefficient health care system and how a handful of proactive hospitals and clinics, faced with the mounting cost of treating the growing number of uninsured, have taken the maxim an ounce of prevention is worth a pound of cure to heart:

To Lower Costs, Hospitals Try Free Basic Care for Uninsured

Unable to afford health insurance, Dee Dee Dodd had for years been mixing occasional doctor visits with clumsy efforts to self-manage her insulin-dependent diabetes, getting sicker all the while.

In one 18-month period, Ms. Dodd, 38, was rushed almost monthly to the emergency room, spent weeks in the intensive care unit and accumulated more than $191,000 in unpaid bills.

That is when nurses at the Seton Family of Hospitals tagged her as a “frequent flier,� a repeat visitor whose ailments — and expenses — might be curbed with more regular care. The hospital began offering her free primary care through its charity program.

With the number of uninsured people in the United States reaching a record 46.6 million last year, up by 7 million from 2000, Seton is one of a small number of hospital systems around the country to have done the math and acted on it. Officials decided that for many patients with chronic diseases, it would be cheaper to provide free preventive care than to absorb the high cost of repeated emergencies.

With patients like Ms. Dodd, “they can have better care and we can reduce the costs for the hospital,� said Dr. Melissa Smith, medical director of three community health centers run by Seton, a Roman Catholic hospital network that uses its profits and donations to provide nearly free care to 5,000 of the working poor. Over the last 18 months, Ms. Dodd’s health has improved, and her medical bills have been cut nearly in half.

Reaching out to uninsured patients, especially those with chronic conditions like diabetes, hypertension, congestive heart failure or asthma, is a recent tactic of “a handful of visionary hospital systems around the country,� said Karen Davis, president of the Commonwealth Fund, a foundation in New York that concentrates on health care. These institutions are searching for ways to fend off disease and large debts by bringing uninsured visitors into continuing basic care.

The public hospital systems in New York and Denver, for example, have both worked to steer uninsured patients to community clinics, charging modest fees, if any. New York’s public system, the Health and Hospitals Corporation, has assigned some 240,000 uninsured patients to personal primary care doctors. A computerized system tracks those with chronic conditions, and when necessary, social workers contact patients to make sure they get checkups and follow medical advice.

“For most preventive efforts there is an upfront expense,� said Alan D. Aviles, president of the corporation. “But over the long term it saves money.�

Denver’s public system, Denver Health, has 41,000 uninsured patients enrolled in its clinics. Officials there calculate that for every dollar they spend on prenatal care for uninsured women, they save more than $7 in newborn and child care. [full text]