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OGDEN - Since she didn't have health insurance, Valorie Johnston got creative when her 6-year-old son, Tanner, needed stitches: She used Super Glue.

She didn't take him to a dentist until she saw a rotting tooth - and then found out he had eight cavities. Last year, fearing her labor was starting too early with her third child, Johnston went to an emergency room, only to discover she had kidney stones.

Without insurance, she explains, "You just wait until there's a crisis that happens and deal with it then."

But Utah's community health centers offer the uninsured an alternative - a prevention-centered approach they believe improves residents' health, reduces costs and should play a key role in the state's health care reform efforts.

The Association for Utah Community Health eventually wants $22.6 million in state funds to care for an additional 100,000 uninsured Utahns.

The 29 centers in 10 counties function like a private family practice - but include more benefits, including pharmacy, dental and mental health. They care for patients regardless of their ability to pay. Of their 98,331 patients last year, 61 percent had no insurance.

For now, Rep. Steven Urquhart, R-St. George, wants to see what the centers can do with $500,000, allocated during this year's Legislature to cover 2,000 to 3,000 uninsured Utahns in Provo and St. George.

"I want them to strut their stuff," said Urquhart, whose wife is on the St. George health center's board. "They already are covering a big part of the problem for us. Does it just make sense to expand out on what they do?"

Checkups, charity care - need a ride?

Johnston recently took her three sons to Ogden's Midtown Community Health Center, where most patients pay $25 a visit. Charged on a sliding scale, clients seek care that ranges from prenatal visits, to immunizations, to help with managing diabetes or cardiovascular disease.

The clinic holds free preventive care each year, screening 2,000 children and 500 women in two days. It was there that Concepcion Solis found out she had cancer in her fallopian tubes. The Ogden grandmother didn't have insurance, so the clinic helped her obtain charity care for a hysterectomy at LDS Hospital in Salt Lake City.

For such specialty care, the centers call on a network of volunteer doctors and hospitals. Caseworkers on a recent day searched for a gastrointestinal doctor for a patient with Hepatitis C and an anesthesiologist for a boy with an abscessed tooth.

The clinic "is very important for a lot of people I know. They don't got a lot of money," Solis said while at the center to arrange a free mammogram at a hospital.

Midtown's on-site pharmacy dispenses drugs at federally mandated reduced prices, so it usually beats Wal-Mart for a three-month supply, said pharmacist Roger Fitzpatrick. It calls patients with chronic diseases who haven't refilled their prescriptions to find out why. Refills tend to drop off at tax time.

A mental health team treats 1,000 patients a year, many of whom had previously used emergency rooms in a crisis.

"We try to break that cycle of returning to the emergency room, so we can keep them stabilized and get more consistent treatment," said therapist Nate Hadley.

Case workers help patients sign up for public assistance, like Medicaid and CHIP, or access available private insurance. They arrange transportation to the center if needed.

Take care of yourself

National studies have shown that such intensive care is actually less expensive. A 2007 study funded by the National Association of Community Health Centers found their patients' medical expenses are $1,800 less than patients seen anywhere else.

Such "medical homes" control costs by preventing sickness, managing chronic illnesses and reducing costly hospitalizations, the association said.

But Midtown medical director Richard Gregoire still sees patients who come in sicker because they don't have insurance. Diabetic patients at Utah's community health centers do not get eye exams, control their blood pressure or test their blood sugar levels as often as similar patients in other states or Utahns with insurance.

Gregoire tries to motivate his patients by pointing out the dangers. "You try to [explain] what may happen if you don't take care of yourself," he said.

One hurdle for some patients: getting an appointment. The Midtown center, along with all four community health centers in Salt Lake County and the one in Provo, are at capacity.

"We're full to the gills," said Dexter Pearce, executive director of the Salt Lake County centers. New slots are only available for pregnant women and their families. "We have to get very, very efficient at saying, 'No.'"

About 20 people are denied an appointment at Midtown daily, said executive director Lisa Nichols. Family physician Kurt Rifleman said one patient with chronic lung disease couldn't get in despite her fever and cough. She landed in the hospital for four days. "If we could have got her in, perhaps we could have avoided a hospital room. It's frustrating," he said.

Recently approved for subsidized insurance, Johnston's trip to Midtown included 3-year-old Tate, who had a persistent cough and diarrhea that had lasted most of his life. Wearing cowboy boots and gently coughing on an exam table, Tate began his first visit to a doctor.

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