Serving the Uninsured: Conducting a Baseline Assessment to Measure the Success of A Local Safety Net in Providing Access to Care

Free and low-cost care for low-income uninsured is delivered through a patchwork of local “safety net” providers: public health departments, public hospitals, community health centers, community organizations, family planning clinics, mobile van programs, private hospitals, and physicians. Services for the uninsured are financed through limited and fragmented local, state, and federal revenue streams.

Community health services planning and policy development is hindered by difficulties in developing a macro-level view across fragmented safety net provider organizations. In Alameda County, California, safety net providers collaborated to address this challenge by conducting a baseline assessment of primary care services to the uninsured, with 2007 as the baseline year. This assessment quantified the number of uninsured being seen across different provider organizations and measured the safety net's capacity through specific indicators such as wait times for primary and specialty care appointments. In addition we present a gap analysis of insurance coverage, safety net expansion needs, and workforce shortages. In the baseline year, approximately 196,000 were uninsured, with more than half accessing primary care through the local safety net. To expand health services to the remaining un-served uninsured population, Alameda County would need to expand the workforce by 95 primary care physicians, with additional mid-levels, specialists, and other health care workers. Moreover, the baseline presents two methods of quantifying the financial resources needed to extend either full insurance coverage or primary and specialty care delivered through the safety net to this population.