Local access to care programs (LACPs) for the uninsured: Sedgwick County Project Access 1999 to 2007, a descriptive epidemiological study

Background: Access to care has risen to the top of the list of national health problems. As a response to the lack of broad federal health care reform, communities have developed local solutions to address healthcare needs of uninsured populations1. However, these programs have been overlooked in health services and health policy research. The purpose of this study was to describe the major health related problems and medical care costs of patients enrolled in Project Access, a community-based, physician-led initiative to expand access to medical services for low-income, uninsured, adult residents of Sedgwick County, Kansas.

Methods: This study served to (1) describe donated physician office and hospital services, (2) identify major diseases affecting the low-income uninsured, (3) document the amount of donated services associated with caring for Project Access patients and compare to selected national indicators, (4) assess changes in perceived health status pre/post enrollment, and (5) estimate return on community benefit (ROCI). All patients with available claims data during the 8 years were included (N = 7,511). Using demographic and administrative data, descriptive frequencies for categorical variables were performed, as well as measures of central tendency for continuous variables. The dependent t-test assessed changes in perceived health status (SF-8).

Results: Patient demographic characteristics remained constant across the 8 program years. Unduplicated hospital services revealed that the majority (76.4%) of patients received outpatient services only. Hospital resource rates as follows: outpatient visits were 8.8 visits per 100 people; inpatient visits totaled 1,241 visits; discharges per 10,000 was 228.4; the average-length-of-stay was 5.3 days. Pre/Post comparison of SF-8 physical and mental health scores revealed a significant improvement in perceived physical health status and a moderate improvement in mental health status; however, scores remained below U.S. population norms. Using unduplicated claims, the median charge per patient for hospital-based charges were approximately $6,000 and physician office services were $1,200; however, a majority patients received medical care from physicians and hospitals for $6,000 or less per year. Approximately 1% of patients consumed nearly 25% of the overall donated charges, more than $14,000,000.

Conclusions: The Project Access partnership provides a valuable service. Although patients have substantially lower perceived physical health status as compared to U.S. population norms, self-reported health status improved post enrollment. Healthcare resources may be conserved through innovative programs that enhance self-care, such as case management provided by both social service providers and nurses. Findings may be useful to health policy planners.