title: Access to care outcomes: a telephone interview study of a suburban safety net program for the uninsured.
abstract: Access DuPage (AD) currently provides primary care for about 14,000 low income, uninsured residents of suburban DuPage County, IL, an area with a very limited healthcare safety net infrastructure. A telephone interview survey evaluated health care utilization, satisfaction, and health status outcomes and compared recent enrollees to individuals in the program for at least 1 year. Sequential new AD enrollees (n = 158) were asked about the previous year when uninsured, while randomly selected established AD enrollees (n = 135) were asked the same questions about the previous year when actively enrolled in AD. Established enrollees reported being more likely to get 'any kind of tests or treatment' (96.3 vs. 46.2 %, p < 0.0001), fewer cost (78.5 vs. 21.3 %, p < 0.0001) and transportation barriers to care, more preventive and mental health services, and better self-management care. However, established enrollees also reported 14 % greater use of hospital inpatient and 9 % greater use of emergency room care, as well as continued difficulty in accessing needed specialty and dental care services. Despite more (diagnosed) conditions, established enrollees were over 2.5 times more likely to report good to excellent health status and over three times more likely to rate their satisfaction with health care as good to excellent. Findings illustrate the substantial benefits of assuring access to care for the uninsured, but do not reflect immediate savings from reduced hospital utilization. Access to care programs will be an important tool to address the needs of the 30 million people who will continue to be uninsured in the United States.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL, 60611, USA, j-feinglass@northwestern.edu.
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
authors.forename: Narissa J
authors.initials: NJ
authors.lastname: Nonzee
authors.forename: Kara R
authors.initials: KR
authors.lastname: Murphy
authors.forename: Richard
authors.initials: R
authors.lastname: Endress
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Simon
mesh_terms: D055812:Community-Based Participatory Research; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007087:Illinois; D007407:Interviews as Topic; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013383:Suburban Population / Q000706:statistics & numerical data*; D013689:Telephone; D016896:Treatment Outcome
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