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Chapter 11 Donated Care Programs: A Stopgap Measure or a Long-Run Alternative to Health Insurance? Jeffrey T. Kullgren Erin Fries Taylor Catherine G. McLaughlin In the wake of the failure to enact broad federal health care reform in 1994, interest in local solutions to the problem of providing health care to the uninsured has grown.– Volunteer-based clinics, sometimes referred to as free clinics, have long been an important source of free or highly subsidized health care for the uninsured, and their numbers have grown substantially in recent years. Other community-based approaches have emerged as outgrowths of the free clinic movement. Project Access, a model that originated in Buncombe County, North Carolina in 1996, is one such approach. Project Access initiatives seek to coordinate and formalize the provision of charity care by local physicians and health care organizations. Although specific details vary by community, these projects are generally structured around primary care and specialist clinicians agreeing to provide free services to a specific number of patients annually. Enrolled patients receive access to primary and specialty care and sometimes access to free or subsidized prescription drugs and other services. Such arrangements allow communities to provide more coordinated care (and often more comprehensive services) than free clinics while still avoiding the state regulation associated with insurance programs. Participation is attractive to clinicians because it enables them to limit their provision of free care to a well-defined number of patients. Further, participating clinicians can provide care to enrollees within their own offices, instead of in a separate free clinic. As of April 2003, 20 communities had implemented projects patterned after Project Access, and over 300,000 uninsured people throughout the United States Jeffrey T. Kullgren, MPH, is an assistant professor of internal medicine in the Division of General Medicine at the University of Michigan Medical School and a research scientist in the VA Center for Clinical Management Research at the VA Ann Arbor Healthcare System. Erin Fries Taylor, PhD, MPP, is an associate director of health research and a senior researcher at Mathematica Policy Research, in Washington, DC. Catherine G. McLaughlin, PhD, is a senior fellow at Mathematica Policy Research as well as a professor of health management and policy at the University of Michigan School of Public Health. Donated Care Programs 121 had received care from donated care programs. In 2002, another 40 communities were planning or contemplating similar initiatives. Project Access programs vary somewhat in their intended purpose. Some are explicitly designed to serve as stopgap measures for temporarily uninsured people on their way to securing health insurance through another source. Others have a longer-term focus, specifically targeting those who foresee few if any affordable health insurance options in the near future (e.g., low-income, selfemployed workers). In this chapter, we examine the early experience of a program in southern Maine called CarePartners, which utilizes a model similar to Project Access. Using data from a telephone survey, we provide information on the baseline characteristics of individuals who enrolled in CarePartners and then examine what happened to participants’ health care coverage in the six months after joining the program. CarePartners, which began in June 2001, offers access to health care services for low-income adults in Kennebec, Lincoln, and Cumberland Counties in southern Maine. CarePartners differs from other Project Access programs, which tend to be organized around local medical societies, in that (1) MaineHealth, a local health system, initiated the program and provides substantial program funding (including staff salaries) and (2) hospitals in the MaineHealth system have worked with their medical staffs to secure physician involvement. CarePartners’ services are provided by seven hospitals (representing all hospitals in the threecounty area, including those outside of the MaineHealth system) and approximately 950 local physicians who have volunteered to provide free health care to low-income uninsured adults. Primary care physicians (PCPs) who participate are each asked to take on 10 patients; specialists are each asked to accept 10 referrals annually. CarePartners was created as a more systematic alternative to local hospitals’ existing charity care programs, which provide free but uncoordinated care to recipients . CarePartners also seeks to provide more comprehensive and coordinated services through a care management component and pharmacy benefits. The program sets its income eligibility levels to match the charity care guidelines of local hospitals in order to discourage unfavorable selection into either CarePartners or charity care programs. At the time of our survey, eligibility criteria for CarePartners required that an individual be an adult aged 18...

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