Recorded presentation

Marcia Wilson, MBA, Holly Mead, PhD Candidate, Marsha Regenstein, PhD, Khoa H. Nguyen, MPH, and Bruce Siegel, MD, MPH. Department of Health Policy, The George Washington University, 2021 K St., NW Suite 800, Center for Health Services Research and Policy, Washington, DC 20006, 202-530-2335, mjwilson@gwu.edu

The nation’s safety net provides primary care for millions of uninsured and underserved individuals. Communities rely on safety net hospitals, health centers, health departments, clinics, individual practitioners and emergency departments to provide these critical services. While safety net services are available in most communities across the country, accessing the care is still problematic for indigent individuals. This study assesses the structure and availability of primary care services within local safety nets in U.S. communities and identifies opportunities for improving access and strengthening service delivery. With support from the Robert Wood Johnson Foundation, ten communities were identified through a national competitive process to undergo an assessment of their local safety net. The study focused on uninsured and underserved residents in the selected communities and the primary care providers who serve them. Data for the assessments were collected through site visits of and interviews with local primary care providers, such as community clinics, hospital outpatient facilities and emergency departments. In addition, thirty focus groups were conducted in six languages with residents who were likely to use primary care services from the safety net. The ten communities differed considerably in the structure and robustness of primary care systems available to uninsured and underserved populations. No single model of care emerged as the ideal system of care for these populations. In some communities, the public hospital is the core of the primary care safety net, while in others, an extensive network of clinics serves as the principal provider of care. Capacity within primary care systems also varied, with some systems exhibiting excess capacity and others not enough. In some cases communities had sufficient capacity but lacked the coordination mechanisms to provide a cohesive system of care. Residents in all communities experienced problems accessing primary care services. Some of the most critical barriers were lack of awareness of available options, cost of care and location of providers. Language and cultural issues were also significant obstacles that many residents face. All the communities need to strengthen the primary care systems within their local safety net. Strategies for improvement, however, depend on each community’s specific problems and local environment. Some communities require additional primary care capacity, while others may benefit from an emphasis on integration of existing resources. Uninsured and underserved residents in all communities would benefit from outreach and education programs informing them of low-cost, conveniently located, culturally sensitive primary care services.

Learning Objectives:

• 1.Describe important components of primary care systems serving uninsured and underserved populations.
• 2.Identify key challenges that uninsured and underserved residents face when trying to access primary care.
• 3.Develop strategies to strengthen primary care service delivery within local safety net systems.

Keywords: Safety Net, Access to Health Care

Related Web page: www.urgentmatters.org

Presenting author's disclosure statement:
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.

Recorded presentation