MarketWatch: Charge of the right brigade? Communities, coverage, and care for the uninsured

Health Affairs

Volumn 25, Issue 3, 2006, Pages

  Brown, Lawrence D ^a,b   Stevens, Beth ^c  

^a Columbia University ^*  (United States)

^b International Center for Health Outcomes and Innovation Research (InCHOIR)   (United States)

^c MATHEMATICA POLICY RESEARCH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMMUNITY CARE; ECONOMICS; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HEALTH CARE QUALITY; HEALTH SERVICES RESEARCH; HUMAN; INSURANCE; LEADERSHIP; ORGANIZATION AND MANAGEMENT; PATIENT; RESOURCE ALLOCATION; RISK FACTOR; SOCIOECONOMICS; UNITED STATES;

COMMUNITY HEALTH PLANNING; COMMUNITY HEALTH SERVICES; HEALTH SERVICES ACCESSIBILITY; HEALTH SERVICES RESEARCH; HUMANS; INSURANCE COVERAGE; LEADERSHIP; MEDICALLY UNINSURED; PROGRAM EVALUATION; RESOURCE ALLOCATION; RISK FACTORS; SOCIOECONOMIC FACTORS; UNITED STATES;

EID: 33744766770     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.w150     Document Type: Review

References (8)

1. A useful overview is D. Andrulis and M. Gusmano, Community Initiatives for the Uninsured: How Far Can Innovative Partnerships Take Us? (New York: New York Academy of Medicine, August 2000).
2. L.D. Brown, "Impermanent Politics: The Hillsborough County Health Care Plan and Community Innovation for the Uninsured," Health Affairs 25 (2006): w162-w172 (published online 11 April 2006; 10.1377/hlthaff.25.w162).
3. The only major new local programs for the uninsured have developed in several California counties in the past two years. Aiming to supply coverage to uninsured children ages 0-5, these programs are funded by a state tax on the use of tobacco and are supplemented by philanthropic grants.
4. Although the analysis of the strategies in this paper concentrates on the major program elements of the seven sites, these elements do not exhaust the sites' CIC-sponsored activities. For example, under strategy I, the federal Health Resources and Services Administration (HRSA) gave Brooklyn an HCAP grant for drug coverage, and in Alameda County, two foundations gave Family Care a total of $1.85 million - a small but not unimportant addition to the $14 million with which the Alliance capitalized the plan. In strategy II, Jacksonville providers donated care to help keep JaxCare affordable, and in Brooklyn, both public and private hospitals agreed to accept discounted fees (which can be treated as being equivalent to donated time). Strategy III contains the donation by Jacksonville's safety-net hospital of $400,000 and of certain tertiary services to JaxCare. Examples of strategy IV include Alameda County's "frequent user" program, which aims to bring counseling and other social services to exceptionally high users of ED care. CIC can properly claim credit for these (and other) initiatives, but their importance is decidedly secondary to those discussed in the text.
5. W.K. Zellers, C.G. McLaughlin, and K.D. Frick, "Small-Business Health Insurance: Only the Healthy Need Apply," Health Affairs 11, no. 1 (1992):174-180;
6. and L.D. Brown, "The Medically Uninsured: Problems, Policies, and Politics," Journal of Health Politics, Policy and Law 15, no. 2 (1990): 413-426.
7. J. Schwartz, All in Good Time: A Memoir (New York: Random House, 2004), 211.
8. Not the least important contribution of CIC and kindred community interventions to expanded coverage is to identify residents who are eligible for Medicaid, SCHIP, and other public programs and speed them on their way to enrollment. A case in point is Alameda County's No Wrong Door program, in which CIC, working with new leadership in the county's social services agency, encouraged a newly "proactive" approach to matching eligible people with public coverage.