Healthcare without insurance is like construction without power tools.
It can be done, but it will take longer and require a lot more effort. And at times you'll feel like you're hammering your thumb.
"Preventive care is one of the most difficult areas," said John Kim, head of the nonprofit Healthy City project, which has amassed data on medical and social resources in the Los Angeles area. "By the time you get care for the condition you're trying to prevent, you might already have it."
But as frustrating as the search can be, there are places to turn for people who have lost their insurance because of layoffs or cutbacks in benefits and don't quality for subsidy programs such as Medi-Cal or Medicare.
Here's a guide to major Los Angeles County resources and what you can expect if you're not covered.
In conjunction with this article, Healthy City has put together a searchable database of hundreds of organizations that provide various kinds of preventive, dental and eye care at no or low cost. It can be found at www.healthycity.org.
The most important thing: Don't neglect vital healthcare.
"One man came into the emergency room at Harbor-UCLA hospital and told doctors he had stopped taking his blood pressure medicine because he didn't have insurance anymore and his doctor refused to see him," said Carol Meyer, interim chief network officer of the Los Angeles County Department of Health Services.
"At the point he showed up, he'd been six months without his medicine. Turns out he had blown out a kidney -- he'll be on dialysis for the rest of his life."
This is one of the few areas of healthcare-without-insurance that's covered by law. If you arrive at a hospital emergency room with a life-threatening condition, you can't be turned away. You can be charged, however. But most hospitals have ability-to-pay programs that adjust the bill on a sliding scale.
If you have no insurance and can't pay, a private hospital can transfer you after you're stabilized to a public facility for continued care.
If you go directly to a county hospital emergency room, you probably will remain at that facility for continued care, if needed. But the wait to be seen for non-life-threatening conditions can be eight hours and more, Meyer said.
If you have the flu, a sprained ankle or other condition that needs care but isn't an emergency, you can go to walk-in clinics where the wait is often a couple of hours or less.
There are more than 100 of these clinics in Los Angeles County that are county-run or under contract with the county. All provide ability-to-pay care for the uninsured. A list of the clinics, by geographic area, can be found on the county health department site, www.ladhs .org.
Hospitals also provide non-emergency care, including surgery, for those who don't have medical coverage. But the wait could be considerable.
"Let's said you have a gallbladder problem that's urgent but not an emergency," Meyer said. "The wait for that surgery in one of our hospitals could be three, even five months."
Don't expect much in the way of physicals or other general exams from the cash-strapped county system. But there are other resources.
A federal program funded through the Centers for Disease Control provides free breast cancer screenings and Pap tests to eligible women. There's also a state-funded program for breast cancer screenings. (See the adjoining box for websites and phone numbers.)
Local health fairs provide blood pressure readings and other tests, often for free, but you have to keep an eye out for these events. There's no centralized listing -- look for announcements in newspapers or at community centers.
If you qualify for free or low-cost care at a hospital or clinic, prescription medications often will be provided on the same basis. In addition, hundreds of programs across the nation provide no- or low-cost medicines to the uninsured. A clearinghouse program started in 2005 by the Pharmaceutical Research and Manufacturers of America trade association makes them easier to find.
Called the Partnership for Prescription Assistance, the program searches for assistance by geography, need and financial status.
"It's for anyone who is uninsured and struggling financially," said Ken Johnson, senior vice president of the trade association. "We've seen an increase in applications of 10% to 15% in the past six months."
Applications are taken at (888) 477-2669 and online at www.helpingpatients.org.
Government-funded dental services often don't go much beyond emergency work.
But we're in luck in Southern California because a few universities here offer dental studies and need folks to . . . well . . . practice on (under the watchful eye of faculty members). The program at UCLA's School of Dentistry, for example, provides care at 50% or less of going rates. But it's not for one-time use.