State Health Reform; Uninsured
This report examines key issues that shape the health care network available to uninsured and under-served residents in Lincoln. It provides background on the Lincoln health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.
The safety net assessment team's analysis of the Lincoln safety net generated the following key findings:
- The safety net in Lincoln, Nebraska, consists of a patchwork of providers with little or no formal collaboration among them.While there are some instances of cooperation among providers, these efforts are limited and Lincoln providers generally undertake their clinical operations independent of one another.
- Limited resources and general physician shortages in Lincoln reduce access to health care for all patients, regardless of their insurance status. Uninsured and Medicaid patients, however, are especially affected by these problems. Uninsured patients experience long wait times for primary care, specialty care, mental health and dental services. Although most physicians in Lincoln and Lancaster County serve Medicaid patients, at least half are not accepting new patients. New Medicaid patients have limited options for seeking health care.
- The safety net lacks referral mechanisms for linking patients without medical homes to community providers. These patients often present to emergency departments with non-emergent conditions. BryanLGH West operates a small case management program that focuses on individuals who have multiple emergency department visits; however, the program is limited and reaches only a small portion of the underserved population.
- A significant percentage of emergency department visits at BryanLGH Medical Center are for patients whose conditions are non-emergent. About 17 percent of all emergency department encounters that did not result in an admission were for patients who presented with non-emergent conditions. Another 18 percent were for patients whose conditions were emergent but could have been treated in a primary care setting.
- Existing interpreter services in the health care community are inadequate. Some interpreter services are available via telephone access lines, but these services may be cumbersome to use and calls may be cut short to conserve resources. Interpreter services are expensive, making it difficult for providers to offer them. The cost of this resource often exceeds the payment providers receive for visits from these patient populations.
- Refugees and immigrants need to be educated in a culturally sensitive manner about use of the health care system, available services, and the importance of receiving preventive care. In particular, educational programs should address how cultural traditions and preferences hinder refugees and immigrants from seeking needed services.
- Transportation remains a major obstacle for uninsured, low-income populations trying to access health care. Bus routes run primarily in the downtown area and do not run at convenient times. Rides to medical providers can take over an hour.
- Latino and black residents report that their needs are overshadowed by those of the New Americans— i.e., refugees who account for a much smaller percentage of underserved residents. Latinos, in particular, believe that their concerns are discounted, largely because many are undocumented and do not enjoy the same legal status as the refugees. Latino residents indicated that they were underrepresented in decision-making positions, including boards of hospitals, clinics and foundations.
Nolan, L., Vaquerano, L., Jones, K., & Regenstein, M. (2004). An assessment of the safety net in Lincoln, Nebraska. Washington, D.C.: Urgent Matters, Safety Net Assessment Team, The George Washington University Medical Center, School of Public Health and Health Services, Department of Health Policy.