Community responses to diabetes and mental health care for the uninsured population in Michigan.
OBJECTIVE
To examine how the safety net in Michigan is responding to the health care needs of their uninsured population with diabetes and/or mental illness.


METHODS
We used a multiple-site case study design. Data were collected through interviews of key informants in five Michigan communities. Analytic patterns and themes were identified, and compared across communities and by organizational type.


RESULTS
Informants reported they are managing to meet the needs of uninsured diabetics but are having great difficulty caring for the uninsured with mental illness. Specialty care for diabetes is obtainable, but is resource-intensive. Mental health services available for uninsured patients are severely limited. The presence of a county health plan (CHP) appears insufficient to improve access, especially to mental health services.


CONCLUSIONS
The safety net for Michigan's uninsured population with diabetes and mental illness is weak. Processes including referrals and care coordination are of poor quality in some communities. The value of integrating mental health services into primary care should be examined.
Dalton
Vanessa K
VK
Department of Obstetrics and Gynecology, University of Michigan Medical School, Women's Hospital, Ann Arbor, MI 48109, USA. daltonvk@med.umich.edu
Jacobson
Peter D
PD
Konig
Madeleine
M
Holman
Peter P
PP
D003153:Community Health Services / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration; D003920:Diabetes Mellitus / Q000628:therapy*; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D017057:Medically Uninsured; D008605:Mental Health Services / Q000458:organization & administration*; D008824:Michigan; D011320:Primary Health Care / Q000458:organization & administration