California's huge uninsured population -- more than 6.5 million people, or more than one in five residents of the state -- is experiencing "widespread problems in (obtaining) access to specialty care," according to a study commissioned by the California HealthCare Foundation.
The study, released today, was based on two statewide surveys of medical directors of all 101 federally qualified healthcare centers, or FQHCs, between November 2002 and April 2003 and 64 California hospitals named by the medical directors as places where they commonly refer uninsured patients in need of specialist care. Mathematica Policy Research conducted the study.
The surveys were followed up by interviews with providers, patients and others in four communities, two in which FQHC medical directors said access to specialty care was good and two in which access was said to be poor.
Overall, 85% the FQHC medical directors said their uninsured patients "often" or "almost always" had trouble obtaining specialty care and that adult access to 16 of 24 specialties was "often" or "almost always" problematic.
Access for children was somewhat better but was reported as "often" or "almost always" a problem for allergists, dermatologists, neurologists and psychiatrists.
Government-owned hospitals represented about half of all hospitals mentioned as major specialty referral destinations by the FQHC leaders, with teaching hospitals following at 25%. Almost all hospitals mentioned were in urban areas. In contrast, only 16% of FQHC medical directors listed physician practices as specialty referral providers.
Few FQHCs had formal contracts with specialists, according to the follow-up interviews, so appointments were arranged on a case-by-case basis. Appointments in certain specialties were hard to obtain at all, the report said, while for others waiting times were "often months long."
Communities with populations that were 40% or more Hispanic were "significantly more likely to report access problems for certain services for adults and children."
To induce more specialists to see uninsured patients, the report recommended that the government employ tax breaks and educational loan repayment schemes to physicians as partial compensation. However, it added, "further research will be needed to identify and explore viable options for expanding health coverage and care access for this population."
The report also advised that national policymakers would do well to investigate whether similar problems in obtaining access to specialty care exist in other states.