title: Small town health care safety nets: report on a pilot study.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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.
authors.affiliation: ptaylor.dc@verizon.net
authors.forename: Pat
authors.initials: P
authors.lastname: Taylor
authors.forename: Lynn
authors.initials: L
authors.lastname: Blewett
authors.forename: Michelle
authors.initials: M
authors.lastname: Brasure
authors.forename: Kathleen Thiede
authors.initials: KT
authors.lastname: Call
authors.forename: Eric
authors.initials: E
authors.lastname: Larson
authors.forename: John
authors.initials: J
authors.lastname: Gale
authors.forename: Amy
authors.initials: A
authors.lastname: Hagopian
authors.forename: L Gary
authors.initials: LG
authors.lastname: Hart
authors.forename: David
authors.initials: D
authors.lastname: Hartley
authors.forename: Peter
authors.initials: P
authors.lastname: House
authors.forename: Mary Katherine
authors.initials: MK
authors.lastname: James
authors.forename: Thomas
authors.initials: T
authors.lastname: Ricketts
mesh_terms: D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007407:Interviews as Topic; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D017664:Uncompensated Care / Q000706:statistics & numerical data