Where to get care? Concerns about provider capacity persist in counties with child health insurance expansions

Background: Children's Health Initiatives (CHIs) formed in California counties have been successfully enrolling children in Medi-Cal, Healthy Families and locally-funded Healthy Kids programs. However, simply having health insurance does not guarantee access to needed services. There is an increased concern about inadequate provider capacity as a limiting factor to well-recognized improvements in access achieved by the CHIs.

Objectives: To investigate whether adequate primary, dental, and specialty care providers are available to support these efforts at the county level and identify barriers to assuring adequate provider capacity.

Methods: CHI directors and coalition members (i.e., representatives from health plans, community clinics, and local child health advocacy organizations) from 31 active CHIs completed an online questionnaire between May-August 2007. A total of 145 individuals were invited: 90 individuals responded (62% response rate). Perceptions of Healthy Kids' overall access to care, the geographic distribution of providers and providers' willingness to serve Healthy Kids were assessed for each provider type using a Likert-type response scale: excellent (3 points), very good (2 points), good (1 point), fair or poor (0 points). Responses from 2006 survey were used in an analysis of changes. County-level data on HPSAs and patient-provider ratios were obtained from the Shortage Designation Branch of the Federal Bureau of Health Professions.

Results: Current provider capacity for primary care was rated good to very good for all three domains (access to care=1.7, geographic distribution=1.4 and provider willingness=1.4); however, major concern was having an adequate number of providers practicing in areas where Healthy Kids enrollees live. Compared to one year ago, declines in capacity for all types of providers were observed and the greatest decline in perceived capacity was in the geographic distribution suggesting a greater perceived disparity between where children in Healthy Kids live and where providers practice. One of major reason why providers are reluctant to serve Healthy Kids is due to lack of capacity to accept new patients. We found that these perceptions are consistent with available empirical measures.

Conclusion: As increased number of children in low-income families gained access to much needed care through the CHIs, this lack of provider capacity is a great concern. Strategies to improve provider capacity are critical to provide adequate care to children in low-income families.