by Jane Bolin and Larry Gamm
The goal of Healthy People 2010’s access to quality health services focus area is to improve access to comprehensive, high quality health care service.1 Access to health insurance is critical to achieving this goal and the related Healthy People 2010 objectives:
· Increase the proportion of persons with health insurance.
· Increase the proportion of insured persons with coverage for clinical preventive services.
Health insurance is an important determinant of health and disability status, likelihood of physician use, and overall likelihood of health care treatment.2 An important determinant of access and utilization of all aspects of health care services, including preventive services, health insurance has a strong influence on a person’s health.3-7
According to a survey conducted by the Rural Healthy People 2010 team, access to quality health services (which includes access to insurance) was most frequently identified as a rural health priority. Approximately three-quarters of the respondents named access to quality health services as a priority.8 It was the most often selected priority among all four types of state and local rural health respondents in the survey and across all four geographic areas.
Persons living in nonmetropolitan areas are more likely to be uninsured than those in metropolitan areas—20 percent versus 17 percent.1 The percentages of persons under 65 who are uninsured are higher in rural areas and large central metropolitan counties than in fringe counties in large metropolitan areas or in small metropolitan counties.9
Estimates using U.S. Census data show that those without health insurance under age 65 total 41.2 million¾an increase of 1.4 million over the 14.2 percent uninsured in the previous year.10 If this annual increase of 0.4 percentage points between 2000 and 2001 in the percentage of uninsured continues at the same rate, 46 million working-age Americans will be uninsured by 2005.11
Among racial and ethnic groups, Hispanics are more likely than other Americans under age 65 to be uninsured (36 percent), and African Americans (21 percent) are more likely than whites (14 percent) to be uninsured. Young adults 19-24 years of age are more likely to be uninsured (32 percent) as are those separated from their spouse (33 percent).12 A total of 8.5 million children, or 11.7 percent of all children, are among the uninsured.10
The majority (57 percent) of the uninsured are full-time workers, while 20 percent are part-time workers. Despite Medicaid programs, the highest rates of uninsured are still in the poor and near poor¾the two lowest¾income groups.13 Several studies report that people living in the South and West have lower rates of private or job-based insurance.9, 10, 14
Studies have shown that in rural areas where there are larger percentages of uninsured, a higher percentage of rural residents also report fair or poor health, no visit to a health professional in the prior year, and less confidence in getting needed health care services.15 A lack of health insurance coverage is associated with lower utilization of preventive services such as cancer screening, and care for congestive heart failure, diabetes, chronic obstructive pulmonary disease (COPD), oral and dental health, and mental health.16, 17
Lower rates of preventive service utilization are documented for rural areas, although differences vary by service. For example, differences in mammogram screening may be more attributable to education or income rather than place of residence. Other preventive services are negatively correlated to rural status and to being uninsured.18 The uninsured are also more likely to be hospitalized for avoidable conditions, such as pneumonia and uncontrolled diabetes, and more likely to be diagnosed for cancer at later stages.19
A number of studies report that working adults living in rural areas are less likely to be offered health insurance through their jobs, i.e., employer-sponsored insurance programs.20, 21 Most of this difference is associated with rural dependence on smaller firms and lower wage rates.21 Prior research shows that rural residents tend to have higher rates of private, self-purchased health insurance and are more likely to be uninsured.15, 21-25
Rural areas tend to have smaller businesses, resulting in higher premium costs for employer-based insurance spread across fewer employees. Combined with higher premiums for such occupations as farming, mining, logging, and fishing, many families may not be able to afford insurance.26 Although only 20 percent of the overall American workforce is employed in firms with less than 25 employees, workers from these small firms account for 42 percent of the uninsured workers in the country.27
During difficult economic times, food and basic necessities are purchased before health insurance, and health insurance is more likely to be dropped or deferred.28 Since persons living in rural areas are more likely to have seasonal work and lower incomes, they are the most at-risk group of being both uninsured and living below federal poverty levels.6, 7, 29
There is a direct correlation between the percentage of those with income at or below the federal poverty level and degree of rurality. Twenty-two percent of the population in rural counties away from metropolitan areas have incomes at or below the federal poverty level compared to 13.8 percent for residents of metropolitan counties, and 15.8 percent among rural counties adjacent to metropolitan areas.15 Higher poverty rates and overall lower wages in rural areas magnify the problem of a lack of employer-based health insurance coverage or coverage that is more costly to workers.
Among the proposed solutions are tax incentives and some regulatory protection for developing MEWAs (Multiple Employer Welfare Associations) or health insurance purchasing cooperatives for smaller employer organizations in some regions of the country. Medicaid extensions and waivers and expansion of the State Children’s Health Insurance Program (SCHIP) are also proposed for persons who are near poverty but Medicaid ineligible. The current economic downturn and state budget shortfalls are likely to restrict these options for addressing the needs of more of the uninsured, at least in the near future.30
A number of communities, led principally by provider groups in those communities, have established special health plans or programs for the uninsured. These programs emphasize the provision of key preventive and other primary health services often associated with reducing demands upon very expensive emergency room services or acute care facilities where such admissions might be prevented by timely primary care.
An important step in community efforts to address the problem of the uninsured is the development of reasonably accurate estimates of the number of uninsured locally. A guide has been developed to support the efforts of community groups to arrive at such estimates.31
Rural
populations in the
The relatively larger proportions of small businesses and lower-paying jobs in rural areas are reflected in fewer employers offering health insurance, fewer choices, and less attractive provisions among employer-sponsored plans. At the same time, both poverty and higher incidence of chronic conditions reflect an increased need for care.
Although there is evidence of some success in certain states in reaching more of the uninsured via extending Medicaid program eligibility and enrolling more previously uninsured children in SCHIPs, current budget cutbacks in most states threaten to reverse this progress. There is evidence, too, of innovative community efforts sponsored by local providers to extend coverage or services to the uninsured. Although providers in many rural areas continue to make major efforts to maintain “safety net” services for the uninsured, it is unclear how long they will be able to maintain them in the face of growing economic challenges to rural populations and providers.
MODELS FOR PRACTICE
The following models for practice are examples of programs utilized to address this rural health issue.
1.
2. Broyles, R.W.; McAuley, W.J.; and Baird-Holmes, D. The medically vulnerable: Their health risks, health status, and use of physician care. Journal of Health Care for the Poor and Underserved 10(2):186-200, 1999.
3. National
Center for Health Statistics.
4. Hoffman, C.,
and Schlobohm, A. Uninsured in
5. Lurie, N.;
Ward, N.B.; Shapiro, M.F.; et al. Termination from Medi-Cal¾does
it affect health?
6. Hagdrup, N.A.; Simoes, E.J.; and Brownson, R.C. Health care coverage: Traditional and preventive measures and associations with chronic disease risk factors. Journal of Community Health 22:387-399, 1997.
7. Casey, M.M.; Call, K.T.; and Klinger, J. The influence of rural residence on the use of preventive health care services. Working Paper #34. Rural Health Research Center, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, 2000.
8. Gamm, L.; Hutchison, L.; Bellamy, G.; et al. Rural healthy people 2010: Identifying rural health priorities and models for practice. Journal of Rural Health 18(1):9-14, 2002.
9. Eberhardt,
M.; Ingram, D.; Makuc, D.; et al. Urban and Rural Health Chartbook,
10. Mills, R.
Health insurance coverage: 2001. Current Population Reports,
11. Employee Benefits Research Institute (EBRI). Brief Executive Summary No. 252. 2002. <http://www.ebri.org/ibex/ib252.htm>January 18, 2003.
12. Rhoades, J.,
and
13. Blumberg,
L., and Liska, D.W. The uninsured in the
14. Rhoades, J.;
Brown, E.; and Vistnes, J. Health insurance status of the civilian
noninstutionalized population: 1998. MEPS Research Finding No.11, AHRQ Pub
No. 00-0023.
15. Ormond,
B.A.; Zuckerman, S.; and Lhila, A. Rural/urban differences in health care are
not uniform across states. New Federalism Series: National Survey of
16. Faulkner,
17. Strickland, J., and Strickland, D.L. Barriers to preventive health services for minority households in the rural south. Journal of Rural Health 12(3):206-217, 1996.
18. Zhang, P.;
Tao, G.; and Irwin, K.L. Utilization of preventive medical services in the
19. Kaiser
Commission on Medicaid and the Uninsured. The uninsured and their access to
health care.
20. Frenzen, P.D. Fewer rural than urban workers receive employment fringe benefits. Rural Conditions and Trends 6(1):22-25, 1995.
21. Coburn, A.F.; Kilbreth, E.H.; Long, S.H.; et al. Urban-rural differences in employer-based health insurance coverage of workers. Medical Care Research and Review 55(4):484-496, 1998.
22. Coward, R.T.; Clarke, L.L.; and Seccombe, K. Predicting the receipt of employer-sponsored health insurance: The role of residence and other personal and workplace characteristics. Journal of Rural Health 9(4):281-292, 1993.
23. Hartley, D.; Quam, L.; and Lurie, N. Urban and rural differences in health insurance and access to care. Journal of Rural Health 10(2):98-108, 1994.
24. Mueller, K.J.; Patil, K.; and Ullrich, F. Lengthening spells of uninsurance and their consequences. Journal of Rural Health 13(1):29-37, 1997.
25. Yen, W.
Health insurance coverage of
26. Mintzer,
C.L.; Culp, J.; and Puskin, D.S. Health care reform: What it means for rural
27. Garrett, B.;
Nichols, L.M.; and Greenman, E. Workers without health insurance: Who are
they and how can policy reach them?
28. Elder, G.H.
Jr.; Tobertson, E.B.; and Ardelt, M. Families under economic pressure. In
Conger, R.D., and Elder, G.H., Jr., eds. Families in Troubled Times:
Adapting to Change in Rural
29. Anonymous. Access to health care for the uninsured in rural and frontier America. National Rural Health Association Issue Paper, 1999. <www.nrharural.org/dc/issuepapers/ipaper15.html>December 10, 2001.
30. Hurley, R.E.; Crawford, H.; and Praeger, S. Medicaid and rural health care. Journal of Rural Health 18 Suppl:164-175, 2002.
31. Socholitzky,
E., and Turnbull, N. How many uninsured: A resource guide for community
estimates, 1999.
32. Gamm, L.,
and
33. Hargraves, J.L. The insurance gap and minority health care, 1997-2001. Center for Studying Health Systems Change, Tracking Report No. 2:1-4, 2002.
34. Stroupe, K.T.; Kinney, E.D.; and Kniesner, T.J.J. Does chronic illness affect the adequacy of health insurance coverage? Journal of Health Politics, Policy, and Law 25(2):309-341, 2000.
35. Taylor, A.; Cohen, J.; and Machlin, S. Being uninsured in 1996 compared to 1987: How has the experience of the uninsured changed over time? Health Services Research 36:16-31, 2001.
36. Weinick, R.;
Zuvekas, S.; and Drilea, S. Access to health care¾sources and
barriers, 1996. 1997 MEPS Research Findings No.3, AHCPR Pub. No. 98-001.
37. Centers for Disease Control and Prevention. Leading Health Indicators at a Glance. <http://wonder.cdc.gov/data2010/lhi.htm>2002.
38.
<http://www.healthypeople.gov/LHI/>2002.
Bolin,
J., and Gamm, L. (2003). Access to Quality Health Services in Rural
Areas—Insurance. Rural Healthy People 2010: A companion document to Healthy
People 2010. Volume 1.
MODELS FOR PRACTICE
FOCUS AREA: ACCESS (INSURANCE)
Program Name: CHOICE Regional Health Network Regional Access
Location:
Problem Addressed: Access to Insurance
Healthy People 2010 Objective: 1-4, 1-5
Web Address: http://www.choicenet.org
SNAPSHOT
The mission of the CHOICE Regional Health
Network, a nonprofit consortium of rural and urban providers, is to “improve
the health of our community.” That “community” represents five counties in
central western
The Regional Access Program (RAP) serves the uninsured and underinsured at or below the 250 percent federal poverty level in the five county service areas. RAP improves access to primary care and other medical services by connecting eligible residents to a medical home and providing guidance on available sources of health insurance.
THE MODEL
Blueprint: CHOICE Regional Health Network Regional Access Program was created in 1996 to provide intensive outreach to low-income individuals and families. Access coordinators partner with schools, providers, daycare providers, state agencies, hospitals, and other community-based organizations to reach children and adults who are without health insurance.
Access coordinators meet individually with clients to explain the various programs for which they are eligible, help them complete the necessary paperwork, and serve as advocates. In 2002, CHOICE helped enroll more than 3,000 people in public insurance. Since the program began, CHOICE has assisted more than 14,000 people in the region to access needed health care services.
The services provided by RAP include:
· outreach to community-based organizations;
· provide a toll-free phone number that connects to a person who prescreens and schedules appointments;
· provide application assistance to complete necessary paperwork and provide follow-up; offer Spanish translation and interpretive services through a toll-free, dedicated Spanish phone line and through four bilingual staff;
· perform enrollment case management when appropriate;
· serve as a liaison between state agencies and clients to facilitate enrollment or to resolve problems;
· educate consumers by explaining benefits and helping clients choose an affordable health plan and primary care physician;
· connect residents to available social services and programs for which they may be eligible;
· produce and distribute marketing materials to reach the target population; and
· provide information to consumers about being informed and responsible health care users, with a focus on primary care.
Making a Difference: The program conducts annual surveys of providers and patients to assess the effectiveness of the program. The impacts of the program for 2001 include:
· reduced the number of uninsured in the region by 3,331;
· decreased the insurance disenrollment rate of CHOICE clients from 30 percent to 10 percent;
· saved the providers in the region $4.5 million in uncompensated care; and
· reduced hospital bad debt and charity care by 14 percent.
Beginnings: The CHOICE Regional Health Network is a nonprofit consortium begun in 1996. Network membership includes public and non-profit hospitals, local health departments, family practice residency programs, practitioners, schools, and community members.
The CHOICE Regional Health Network takes on new and/or expands existing programs based on an assessment of factors that reflect their mission and vision. The questions asked as criteria for program selection for the Regional Access Program are:
· Does this initiative make sense regionally?
· Is the problem important and in the long-term interests of the community?
· Does it address a coordination, quality, access, or health status objective?
· Is it a step toward better distribution of health resources?
· Is it a prudent investment in a cost-conscious market?
Challenges and Solutions: To address social and cultural issues, case management services were created to connect people to other needed services (e.g., food). Bilingual staff were hired to address language and cultural issues. Special materials were developed to assist clients from other cultures to understand the concepts of insurance, medical home, and managed care. Recently, CHOICE partnered with the Crisis Clinic to manage an Internet-based Regional Resource Directory.
Ongoing funding for the network comes from membership dues that are paid by the six public and non-profit hospitals (member sponsors). This funding is supplemented with state contracts and grants. For example, the Statewide Health Insurance Benefit Advisor (SHIBA) Program was folded into the RAP program. Savings from reductions in uncompensated care are reinvested back into the program. In 2001, the program received a Community Access Program (CAP) grant from the Health Resources and Services Administration. Expanded funding over the last five years allows the program to increase its service population, adding children, the underinsured, and additional counties (from one to five).
PROGRAM CONTACT INFORMATION
Kristen West
CHOICE Regional Health Network Regional Access
Phone: (360) 493-4550
MODELS FOR PRACTICE
FOCUS AREA: ACCESS (INSURANCE)
Program Name: Inland Northwest in Charge - coordinated by the Health Improvement Partnership
Location:
Problem Addressed: Access to Insurance
Healthy People 2010 Objective: 7
Web Address: www.hipspokane.org
Blueprint: Inland Northwest in Charge is a collaborative project coordinated by the Health Improvement Partnership (HIP), a 501(c)(3) nonprofit organization involving representatives from over 200 organizations. INIC seeks to improve health care access for the uninsured and underserved, including outreach and enrollment efforts for state-sponsored health care, referrals to primary and specialty/chronic disease care, designing and implementing an affordable insurance product (which combines public and private dollars) for the working uninsured, and access to additional health-related resources (e.g., affordable pharmaceuticals).
HIP serves
uninsured children in
INIC provides marketing and outreach services, a staffed hotline for client application assistance, training and technical assistance on state-sponsored health care for community professionals and outreach workers, one-on-one outreach in rural and tribal areas, coalition building, assistance to community partners in program and resource development, and capacity building for outreach and health care access in rural communities. Program coordinators at the Health Improvement Partnership work with diverse community stakeholders to define priorities and workplans. Internal staff, consultants, and contracted workers finalize action plans and implement activities.
Making a Difference: INIC tracks the number of people reached, served, and connected with health insurance and/or primary care. Over 16,000 individuals have been enrolled in coverage or directed to primary care since 1999. Surveys are given to clients regarding their coverage retention and satisfaction with the services. INIC works to build more outcome measures to assess the effectiveness of the programs. Base-line data are gathered on hospital charity/uncompensated care levels, emergency room primary care usage, and unnecessary admits to measure the long-term impact the programs have on these indicators.
Beginnings: INIC began in November 1998 and was fully implemented in January 1999. INIC first received funding from a contract with the Department of Social and Health Services’ Medical Assistance Administration for designing and conducting Medicaid outreach. Additional significant funding was subsequently received from a Robert Wood Johnson Foundation grant and a Health Resources and Services Administration Community Access Program grant. INIC draws upon a mix of local, regional, state, and national funds.
Challenges and Solutions: Challenges include maintaining enough ongoing funds to test and fully implement new methodologies for serving the population; having adequate time, staffing, and resources to balance both the planning and implementation sides of the programs; and retaining the ongoing involvement of community partners. INIC addresses these challenges in a variety of ways, including:
Lisa Capoccia and Dan Baumgarten
Inland Northwest in Charge - coordinated by the Health Improvement Partnership
Phone: (509) 444-3088 x 216
Fax: (509) 444-3077
E-mail: deannad@hipspokane.org
MODELS FOR PRACTICE
FOCUS AREA: ACCESS (INSURANCE)
Program Name: Lake Plains Community Care Initiative
Location:
Problem Addressed: Access to Insurance
Healthy People 2010 Objective: 1-4, 1-6
Web Address: None
The Lake Plains Community Care Network (LPCCN) is a not-for-profit corporation formed in 1997 from a network of employers, providers, and community service groups and organizations that have collaborated since 1993. The network addresses rising costs of health care and the dwindling choices of health care services in rural areas. The Lake Plains Community Care Initiative is one of several community-oriented programs under LPCCN.
Blueprint: The
Lake Plains Community Care Initiative is a local response strategy that targets
growing concerns over access to and affordability of quality health care and
health insurance coverage for the area residents. LPCCN exists as a three-county,
rural health network located in upstate
As a rural health network, LPCCN seeks to offer open-ended service support to all 150,000 individuals residing within the catchment area. Insurance efforts are directed toward offering support to uninsured and underinsured adults and their families. The targets are individuals who are typically self-employed or employed in small group environments (organizations with 50 employees or less). Many of these individuals are employed in agribusiness, retail, or the service industry. The Lake Plains Community Care Initiative seeks to better coordinate and strengthen the local health delivery system while at the same time promoting additional competitively priced health insurance options to the communities. This is accomplished by two methods. First, LPCCN established a three hospital, 160 physician, messenger model (a type of preferred provider organization [PPO] that was established by the Federal Trade Commission to allow physicians to negotiate reimbursements) to coordinate and strengthen the overall delivery system. Gradually, the PPO will be enhanced through the provision of local support features or functions such as local medical management, case management, community care management, and utilization review efforts. Second, LPCCN attempted to reach local self-insured organizations, employment-sector trusts, and a third party commercial carrier to contract with the PPO and actively take advantage of the enhancements being provided.
Making a Difference: The Lake Plains Community Care Initiative covers approximately 2,400 lives by servicing health insurance plans. The Initiative expects to add 1,000 more covered lives in 2002.
Beginnings: LPCCN
was incorporated in 1997, and the first service contract took effect in July
2000. The problem was noticed beginning in the early 1990s when the provider
system began losing market share and experienced increasing difficulties in
meeting financial objectives and attracting new practitioners to the
communities. The numerous insurance carriers decreased as well as the consumer
responsiveness of those that remained. As Lake Plains gained in local
prominence and stature, LPCCN commissioned a market analysis through the
Challenges and Solutions: Lake Plains Community Care Initiative has experienced varied
challenges over the past several years. All health insurance activities in
LPCCN has been funded as a New York State Rural Health Network since 1997 and has also benefited from a federal rural network development grant, Kellogg Foundation grant award, and member organization contributions. The organization anticipates becoming self-sufficient by 2004 as the revenue stream grows from increased utilization of PPO services within the community.
Kenneth L. Oakley, Ph.D., FACHE
Lake Plains Community Care Initiative
Phone: (585) 345-6110
Fax: (585) 345-7452
MODELS FOR PRACTICE
FOCUS AREA: ACCESS (INSURANCE)
Program Name:
Location: Harlan,
Perry, Leslie, and
Problem Addressed: Access to Health Care, Housing, Education, and Public Safety
Healthy People 2010 Objective: 1-4, 1-6
Web Address: http://www.mc.uky.edu/ruralhealth/community_programs/skycap.htm
The
Southeast Kentucky Community Access Program (SKYCAP) is a rural demonstration
and evaluation program funded by the Health Resources and Services
Administration, U.S. Department of Health and Human Services, and launched on
September 1, 2000. The purpose of SKYCAP is to identify collaborative partners
in rural communities in southeast
Blueprint: SKYCAP
is a collaborative demonstration program designed to improve access to health
care, social services, and housing for the underinsured and uninsured residents
of Harlan and
SKYCAP also takes referrals from different agencies. Delivery of services is achieved by deploying family health navigators (FHNs) in 11 community sites as community health advisors to assist eligible clients with ambulatory care sensitive diseases (asthma, cardiovascular disease, diabetes, hypertension, or severe mental illness) to receive care in the most appropriate settings.
FHNs serve the uninsured and underinsured population by conducting home visits, performing assessments of clients and family needs, and providing referral information to clients and their families. The family health navigators also act as liaisons between clients and their families as well as mental health and health and human service providers. FHNs report to network members the specific characteristics or conditions that impede clients from obtaining available services. In addition, FHNs work with multidisciplinary teams to establish action plans for clients and families. They assure that action plans are carried out, link clients with all needed services, connect clients to support groups, and provide emotional and educational support for clients and their families.
SKYCAP is a community partnership with the University of Kentucky Center for Rural Health in Hazard; Harlan Countians for a Healthy Community, Inc.; Hazard Perry County Community Ministries, Inc.; and Data Futures, Inc. These community partners bring together over 50 other partners and organizations, such as health departments, local hospitals, pharmacies, and mental health centers.
It
is estimated that 24 to 45.4 percent of the population in these counties lives
in poverty (compared to
Although Medicare covers 26 percent of the people in these counties, and most children have some sort of public or private insurance, about 12,000 people are still medically indigent. In addition, approximately 10,000 people are Medicaid recipients, of which the majority are otherwise uninsured. The greatest need in this two-county area is access to pharmaceuticals.
Making a Difference: The SKYCAP program formed a baseline of medical/social care utilization for the following diseases: asthma, diabetes, heart disease, hypertension, and mental illness. By the end of 2001, SKYCAP received over 5,000 referrals from different agencies and provided a total of 13,000 services. These are services that otherwise would probably be unavailable to these people due to being uninsured or underinsured.
Beginnings:
The SKYCAP program was fully implemented in December 2000 and provided services
to Harlan and
Challenges and Solutions: By collaborating across the mountains,
SKYCAP attempts to create a comprehensive network for this most distressed
area. It supports integrated programming to increase access to health care for
the target populations. The program seeks to expand a CAP network of safety net
providers that will serve this Appalachian region and can be easily replicated
throughout
Fran Feltner, Program Director
University of
Phone: (606) 439-3557
Fax: (606) 436-8833
MODELS FOR PRACTICE
FOCUS AREA: ACCESS (INSURANCE)
Program Name:
Location:
Problem Addressed: Access to Insurance
Healthy People 2010 Objective: 1-4, 1-6
Web Address: http://www.vccu.net/
The Vermont Coalition of
Clinics for the Uninsured (VCCU) is a group of free health care clinics and one
dental clinic in Vermont that work together to provide a safety net of primary
care services to individuals whose household incomes fall below 200 percent of
the federal poverty level (FPL) and who either lack health insurance entirely
or are underinsured (e.g., high deductibles). The nine member clinics are
distributed around the state, and although each has its own board of directors,
each clinic maintains its own policies and does its own fundraising. Some
funding (from the State of
Blueprint: VCCU
is comprised of free health care clinics and one dental clinic that provide
safety-net primary care services to uninsured and underinsured individuals who
fall below 200 percent of the poverty level. It specifically serves the
low-income uninsured and underinsured between the ages of 18 and 65. Few
children need the clinics since
The majority of the member clinics operate as freestanding health care facilities and are staffed by medical volunteers. These clinics provide services based on the traditional free clinic model, which means that services are provided on a weekly to tri-weekly basis in the evenings. The remainder of the clinics operate through local hospitals and local medical care practices to incorporate their clients into the mainstream provision of health care services. This method is known as the incorporated model. The success of VCCU relies heavily on the over 500 volunteers who include physicians, nurses, allied health professionals, and administrative assistants. Examples of free services provided by the clinics include primary health care, referral for testing and specialty care, enrollment in social services and Medicaid extension programs, prescription medications, and case management. The clinics developed a case management model to ensure continuity of care.
Making a Difference: The clinics now serve about 20 percent of the state’s uninsured population. Their constituents are the unemployed and working poor. About 60 percent are women, and most clients fall into the 30 to 45 age category. Most are high school graduates and are employed. In fact, there is a trend in the client base toward multiple jobs. Of those with some insurance, 68 percent have insurance with deductibles of $250 or more. According to these data, there are an increasing number of underemployed clients who are also underinsured.
Beginnings: The
VCCU program began in 1994 and was fully implemented by 1995. Each clinic was
developed by a grassroots effort within that community, and each program works
closely with its local hospital and medical community. VCCU offers support to
any community wishing to start a free clinic and provides technical assistance
to that community. VCCU grew from an informal group of five clinics to a
501(c)(3) organization with nine clinics after receiving funding from the Rural
Health Outreach Program of the Federal Office of Rural Health Policy. At the
end of that three year funding period, the State of
Challenges and Solutions: The health care situation in
Sonja Olson
Phone: (802) 388-2753
Fax: (802) 388-3758