Increasing Access to Care for the Medically Underserved: Four County Models

Obtaining regular health care is a problem for many Californians. The uninsured—6.6 million Californians—tend to use fewer preventive services and delay seeking appropriate care. In this study, we examined four California counties—Humboldt County, Fresno County, Solano County, Santa Cruz County--with limited resources to increase our understanding of key factors important to planning and implementing access initiatives. All have been involved in countywide planning activities focusing on access, such as a Children's Health Initiative (CHI), and all have an access coalition dedicated to planning and launching access initiatives. Informants included representatives from the county health agency, the local access coalition, the Medi-Cal managed care plan, and providers. The findings indicated that four study counties have numerous access initiatives underway and are considering providing insurance coverage for low-income adults. Information technology continues to evolve albeit in a piece-meal fashion. Similarly, counties are on the path to integrated systems of care and are focusing primarily on integrating mental health services in primary care settings. A coalition approach affords them the ability to secure resources and implement access initiatives they might not otherwise undertake. Clearly there are limits to what counties can do; however, they can provide the means and the motivation for addressing intractable problems in innovative ways. Though there are differences in the resources that counties bring to bear for health care for low-income populations, there are specific strategies and models, such as the access coalition, that can be adopted by others.