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Low-Income People Face Serious Gaps in Specialty Care

Holes in Safety Net for Specialty Physician, Mental Health and Dental Services

News Releases
June 17, 2004

Alwyn Cassil: (202) 264-3484

ASHINGTON, D.C.—Despite signs that low-income and uninsured people’s access to primary health care services has improved, serious gaps in care exist, especially for specialty physician, mental health and dental care, according to a study released today by the Center for Studying Health System Change (HSC).

"Access to specialty care is a long-standing—and in some cases worsening—problem in many communities, and as a result, many low-income people likely face delayed care, untreated conditions and poor outcomes," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

The study’s findings are detailed in a new HSC Issue BriefHealth Care Access for Low-Income People: Significant Safety Net Gaps Remain. The study is based on HSC’s 2002-03 site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

"Many low-income and uninsured people turn to private physicians and dentists, but access to these providers has declined in recent years," said HSC Research Analyst Laurie E. Felland, coauthor of the study with HSC consulting researchers Suzanne Felt-Lisk and Megan McHugh, both of Mathematica Policy Research Inc.

The study identified four reasons why gaps in access to specialty, mental health and dental care persist:

  • Private physicians and other caregivers’ willingness to treat uninsured people and people covered by Medicaid and the State Children’s Health Insurance Program (SCHIP) is a challenge in most communities. Across the communities, low Medicaid and SCHIP payment rates—especially relative to commercial payments—were cited as major obstacles to provider participation.
  • State budget shortfalls have prompted funding cuts for mental health and dental services, both of which are financed primarily through Medicaid.
  • In some communities, changes in organizations’ commitment to specialty services have created noticeable gaps.
  • Increased demand has contributed to access problems in some communities, especially those with growing numbers of immigrants and newly unemployed people.

Many of the HSC communities have tried to improve access to services, often with the help of federal or state funds. Strategies include expansions to community clinics and initiatives to promote provider volunteerism or pay practitioners for treating the uninsured.

As policy makers seek to improve access to health care services through the safety net, lessons can be learned from local experiences, according to the study. Because low payment rates appear to be a major barrier, attempts to create or increase payments to private providers for treating low-income and uninsured people may have potential. But continued budget shortfalls likely will hinder state and local governments’ ability to do this.


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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.