Methodological techniques and tools used to develop and evaluate community healthcare access programs in Lane County, Oregon

United Way of Lane County, Oregon has been conducting a random-digit dial Community Needs and Assets Study approximately every three years since 1992. In 2004, results indicated, for the first time, that access to healthcare, affordable medications and health insurance were the top three needs of people across all socioeconomic, age and geographic groups. To address this critical community issue, the 100% Access Healthcare Coalition was formed by healthcare, business non-profit and government stakeholders.

In an effort to better understand the scope of services required, geographic disparities and financial resources being directed toward uncompensated care, the Coalition funded an independent assessment of emergency department (ED) utilization at the County's four hospitals in 2005 and 2006. Results were used to identify gaps in access and create policies for a new limited community health benefit program for uninsured residents. Both community assessments were repeated in 2007 following implementation of various projects designed to improve healthcare capacity and coordination.

In 2004, 20% of residents grossing at least $34,000 per year reported not being about to pay for medical insurance; compared to 68% of residents earning less than $34,000. Fifty-two percent of Medicaid recipients reported interruptions in health care coverage over the past two years. The instability of Medicaid coverage was supported by ED utilization trends. County-wide, ED visits for behavioral health conditions exceeded statewide estimates and geographic disparities were readily apparent.

Results for 2007 assessments, related outcomes research and subsequent policy and program development decisions will be reviewed.