Awareness of Safety Net Providers by Uninsured Persons

Awareness of Safety Net Providers by Uninsured Persons.

Cunningham P, Hadley J, Kenney G, Davidoff A; AcademyHealth. Meeting (2005 : Boston, Mass.).

Abstr AcademyHealth Meet. 2005; 22: abstract no. 2998.
Center for Studying Health System Change, , 600 Maryland Avenue, S.W., Suite 550, Washington, DC 20024 Tel. 202-484-4242 Fax 202-484-9258

RESEARCH OBJECTIVE: It is generally acknowledged that health care providers who offer services for free or at reduced cost play an important role in providing at least a minimum level of access to care to uninsured persons. However, the effectiveness of these safety net providers may be limited to the extent that many uninsured parent aware of these providers. This research examines the extent to which uninsured persons are or are not aware of safety net providers in their communities; examines a variety of health system, policy, and sociodemographic characteristics associated with safety net awareness; and explores the implications of awareness or lack of awareness for access to care. STUDY DESIGN: Data are based on the 2003 Community Tracking Study household survey. The survey included questions asked of uninsured persons and their family members as to whether or not they paid full or reduced cost at their usual source of medical care, or if they were aware of providers in their community who offered affordable care to uninsured persons. Uninsured respondents who were aware of safety net providers were also asked the type of place (e.g. physicians office, hospital-based facility, clinic). A multinomial logistic regression analysis is conducted to examine the effects of various health system, policy, and sociodemographic characteristics on awareness of the different types of safety net providers. We focus especially on the effects of local safety net capacity on awareness, such as safety net hospitals, community health centers, and physician charity care, as well as the impact of Community Access Program (CAP) grants, all obtained through secondary data and linked to the CTS household survey. We also examine whether awareness of safety net providers is associated with fewer unmet medical needs. POPULATION STUDIED: Nonelderly uninsured persons PRINCIPAL FINDINGS: Less than half of the uninsured (47.5 percent) reported that they used or were aware of a safety net provider in their community that offered subsidized services to the uninsured. Among those uninsured who were aware of a safety net provider, most identified clinics and health centers (44.6 percent) and physicians offices (26.1 percent) as the safety net provider they were aware of. Fewer uninsured identified hospital outpatient clinics (12.9 percent) and emergency departments (8.3 percent) as safety net providers. The results of the regression analysis show that higher capacity of safety net hospitals, CHCs, and physician charity care increases awareness of safety net providers. The presence of CAP grants in the community also increases safety net awareness. Nevertheless, many uninsured remain unaware of safety net providers despite living in close proximity to a safety net provider. Awareness of safety net providers was also associated with fewer unmet medical needs. CONCLUSIONS: Many uninsured are not aware of safety net providers, including many who live near a major safety net provider such as a public hospital or community health center. Greater awareness of safety net providers is associated with improved access, although further research is needed to more firmly establish the causal link between safety net awareness and access. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Increasing awareness of safety net providers may be as important in improving access as increasing capacity in the system. Just as outreach efforts have been critical for enrolling eligible children in public insurance programs, outreach activities may be important in increasing awareness of safety net providers by uninsured persons.