Small Town Health Care Safety Nets: Report on a Pilot Study

Authors

Pat Taylor PhD
Lynn Blewett PhD, University of Minnesota Twin Cities
Michelle Brasure PhD, University of Minnesota Twin Cities
Kathleen Thiede Call PhD, University of Minnesota Twin Cities
Eric Larson PhD
John A. Gale MS, University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research CenterFollow
Amy Hagopian MHA, University of Washington, Department of Health Services
L. Gary Hart PhD, University of Washington, WWAMI Rural Health Research Center
David Hartley PhD, MHA, University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center
Peter House MHA, University of Washington, Department of Health Services
Mary Katherine James MPH
Thomas R. Ricketts PhD, University of North Carolina at Chapel Hill

Document Type

Article

Publication Date

1-1-2003

Keywords

Health Policy, Health Services Accessibility, Health Services Needs and Demand, Health Services Research, Humans, Insurance Coverage, Interviews as Topic, Medically Uninsured, Medicare, Pilot Projects, Primary Health Care, Rural Health Services, Uncompensated Care, Cutler Institute, Population Health and Health Policy, USM Aging Initiative, Health and Wellness

Publication Title

The Journal of Rural Health

Abstract

CONTEXT: Very little is known about the health care safety net in small towns, especially in towns where there is no publicly subsidized safety-net health care.

PURPOSE: This pilot study of the primary care safety net in 7 such communities was conducted to start building knowledge about the rural safety net.

METHODS: Interviews were conducted and secondary data collected to assess the community need for safety-net care, the health care safety-net role of public officials, and the availability of safety-net care at private primary care practices and its financial impact on these practices.

FINDINGS: An estimated 20% to 40% of the people in these communities were inadequately insured and needed access to affordable health care, and private primary care practices in most towns played an important role in making primary care available to them. Most of the physician practices were owned or subsidized by a hospital or regional network, though not explicitly to provide charity care. It is likely this ownership or support enabled the practices to sustain a higher level of charity care than would have been possible otherwise. In the majority of communities studied, the leading public officials played no role in ensuring access to safety-net care.

CONCLUSIONS: State and national government policy makers should consider subsidy programs for private primary care practices that attempt to meet the needs of the inadequately insured in the many rural communities where no publicly subsidized primary safety-net care is available. Subsidies should be directed to physicians in primary care shortage areas who provide safety-net care; this will improve safety-net access and, at the same time, improve physician retention by bolstering physician incomes. Options include enhanced Medicare physician bonuses and grants or tax credits to support income-related sliding fee scales.

Comments

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Recommended Citation

Taylor, P., Blewett, L., Brasure, M., Call, K. T., Larson, E., Gale, J., . . . Ricketts, T. (2003). Small town health care safety nets: Report on a pilot study. Journal of Rural Health, 19(2), 125-134.