 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Peter D. Jacobson, JD, MPH, Department of Health Management and Policy, University of Michigan School of Public Health, 109 Observatory, Ann Arbor, MI 48109-2029, 734-936-0928, pdj@umich.edu, Carol S. Weisman, PhD, Professor, Dept. of Health Management and Policy, Director, Interdepartmental Concentration in Reproductive and Women's Health, University of Michigan, 109 South Observatory, Room M3138, Ann Arbor, MI 48109-2029, and Vanessa K. Dalton, MD, MPH, Obstetrics and Gynecology, University of Michigan Hospitals, 1500 E. Medical Center Dr., L4000 Women's, Ann Arbor, MI 48109-0276.
To understand how organizations serving uninsured and underinsured populations make choices about their future roles and services, we conducted qualitative case studies of 22 health care safety net organizations in Michigan. We found that unmet need continues to rise—expanding faster than organizational capacity. Key adaptive strategies being developed to cope with increasing demand vary widely by organizational type and geographic location.
Most organizations are developing new strategic plans, with some based on “mission transforming” strategies and others continuing highly specific missions (i.e., faith-based). “Mission transforming” organizations, usually clinics in more affluent areas and those with direct federal financial support, are expanding service delivery options and are more active in soliciting funding. In contrast, smaller organizations, especially those retaining a narrower mission of serving the poor or those in less affluent areas, have been forced to turn away new patients. The level of available community resources, particularly physician volunteers, helps explain differences across organizations.
Despite dedicated staff and volunteers, health care safety net services in Michigan are under severe pressure. Adaptive strategies will enable most to fulfill their mission, but will not be sufficient to respond to increasing demands for services. “Mission transforming” organizations are in a better position to expand their reach. Nonetheless, policymakers cannot rely on health care safety net organizations to meet the burgeoning needs of the uninsured population. New structures and strategies, such as regionalizion, need to be considered, but increased federal funding may be the only viable option for expanding organizational capacity.
Learning Objectives:
Keywords: Organizational Change, Public Health Infrastructure
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.