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APHA Scientific Session and Event Listing

Mathieu R. Despard, MSW, School of Social Work, University of North Carolina at Chapel Hill, 301 Pittsboro Street, CB 3550, Chapel Hill, NC 27599-3550, 919-962-6467, despard@email.unc.edu and Frank M. Lombard, LCSW, Center for Health Policy - Health Inequalities Program, Duke University, 302 Towerview Road, Rubenstein Hall, Durham, NC 27708.

Absent state or federal policy changes to provide health coverage for uninsured adults ages 19-64, communities are increasingly organizing to expand local health care safety net services beyond offering primary medical care access. Understanding the characteristics and dynamics of the local health care delivery system as well as the relationship between local government and medical care providers is important in crafting appropriate solutions.

A project funded under the federal Bureau of Primary Health Care's Healthy Communities Access Program to develop a system of care for uninsured persons co-infected with HCV/HIV joined an initiative to increase access to specialty care among the uninsured.

A series of conversations and planning meetings ensued with and among a local health department, academic health center and faculty practice, independent physician association and federally qualified health center to explore different models of expanding the safety net to include non-emergent outpatient specialty medical care.

Considerations for determining the most feasible, sustainable and fair cost-sharing approach include the 1) level of activity and interest of the local medical society compared to the role of an independent physician association in soliciting physician support; 2) current level of charity and uncompensated care offered by an academic health center and the competing demands of research and teaching among its faculty; 3) role of the FQHC in providing a medical home and prescription medication access to the target population and 4) intentions of local government concerning a health trust fund established following a public hospital conversion.

Learning Objectives:

• Identify the degree to which uninsured adults 19-64 access specialty medical care in a community.
• Compare and contrast the feasibility and sustainability of various health care safety net approaches based on an understanding of the local health care delivery system.
• Articulate the issues and challenges to facilitating public-private partnerships to improve local health care safety nets in communities with academic health centers.

Keywords: Underserved Populations, Health Care Access

Presenting author's disclosure statement:

Not Answered