Local access to care programs (LACPs): new developments in the access to care for the uninsured.
BACKGROUND
New, locally based health care access programs are emerging in response to the growing number of uninsured, providing an alternative to health insurance and traditional safety net providers. Although these programs have been largely overlooked in health services research and health policy, they are becoming an important local supplement to the historically overburdened safety net.


METHODS
This article is based on a literature review, Internet search, and key actor interviews to document programs in the United States, using a typology to classify the programs and document key characteristics.


RESULTS
Local access to care programs (LACPs) fall outside traditional private and publicly subsidized insurance programs. They have a formal enrollment process, eligibility determination, and enrollment fees that give enrollees access to a network of providers that have agreed to offer free or reduced-price health care services. The forty-seven LACPs documented in this article were categorized into four general models: three-share programs, national-provider networks, county-based indigent care, and local provider-based programs.


CONCLUSIONS
New, locally based health access programs are being developed to meet the health care needs of the growing number of uninsured adults. These programs offer an alternative to traditional health insurance and build on the tradition of county-based care for the indigent. It is important that these locally based, alternative paths to health care services be documented and monitored, as the number of uninsured adults is continuing to grow and these programs are becoming a larger component of the U.S. health care safety net.
Blewett
Lynn A
LA
State Health Access Data Assistance Center, School of Public Health, University of Minnesota, Minneapolis MN 55455, USA. blewe001@umn.edu
Ziegenfuss
Jeanette
J
Davern
Michael E
ME
D003153:Community Health Services / Q000145:classification / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000145:classification / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D019458:Insurance Coverage / Q000145:classification / Q000458:organization & administration; D009111:Local Government; D008329:Managed Care Programs / Q000145:classification / Q000458:organization & administration*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000145:classification / Q000458:organization & administration*; D013221:State Health Plans / Q000145:classification / Q000458:organization & administration*; D014481:United States
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