Projects in 14 communities designed to expand health insurance coverage and improve care for the uninsured have had disappointing results, according to a study published in Health Affairs. The projects funded by Robert Wood Johnson’s Communities in Charge program during 2000 to 2003 were fraught with too many political, economic, and organizational obstacles to make a dent in solving the healthcare problems of the uninsured, say the authors, who explore why seven of the community initiatives failed.
In Jacksonville, Fla., for example, $2.5 million in public funds were earmarked to provide health insurance for 1,500 working residents. The hospitals agreed to discount their prices, a set of benefits was specified, and information technology was improved to provide efficient care for these residents. But in the end, only 70 people enrolled in the program. In Jackson, Miss, the goal was to shift patients who used the emergency rooms for non-urgent care to less expensive primary-care clinics. Hospital staff agreed to make the referrals, but patients gave incorrect phone numbers and addresses, believing that the volunteer employees were connected with a welfare or bill collection agency. And when patients tried the primary-care clinics, they found a four-week wait for appointments. Consequently, they found it easier to continue using the emergency rooms.
“Notwithstanding a couple of medium-wattage points of light, CIC offers little hope that communities can or will make major breakthroughs in expanding coverage or care for the uninsured,” wrote the study’s authors. Click here to read the study.
