Tennessee and the Underserved

151 Presentation TENNESSEE AND THE UNDERSERVED J. W. LUNA Commissioner Tennessee Department of Health and Environment We in Tennessee care deeply about health care for the poor and underserved. It has been a major priority of Governor Ned McWherter and his administration , and has been a topic of much discussion and planning during the past few years. We have conducted a good deal of research and have recently begun some innovative programs for assuring that the poor and underserved receive health care. Tennessee, by almost anyone's definition, is a poor state. We have a poverty rate more than four percentage points above the national average. Percapita income is about 17 percent lower than the national average. Our state tax collections lag behind those of every southeastern state but Mississippi. We are a proud state, however, and we want to take care of our own. Our nickname is the "Volunteer State," and we have a long tradition in Tennessee of pitching in to help each other in times of need. Governor McWherter's first act as Governor was to issue an Executive Order forming a Cabinet Council on Indigent Care. This council is chaired by the Commissioner of Finance and Administration and includes the Commissioners of Health and Environment; Mental Health and Mental Retardation; Commerce and Insurance; and Human Services. The cabinet council appointed an advisory board consisting of representatives of health care providers and consumers. The cabinet council and the advisory board held hearings in many areas of Tennessee. Members of my staff gathered extensive data to learn as much as we could about patterns of health care delivery in the state, and about gaps in coverage. We reviewed Medicaid and hospital data on where individuals of each county in the state receive their ambulatory and hospital services. We looked at migration patterns for health care, asking questions about where people customarily go for health care and how far these services are from where people live. We talked with professionals working at the local level to get a feel for idiosyncrasies in patterns of health care access that might not be obvious from charts and statistics. We found, for example, that one can travel north and south Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 152 Tennessee and the Underserved in Scott County, but because of mountains, not east and west. And we found that for unexplained reasons, very few people habitually cross the Tennessee River, whose bridges form major thoroughfares, to get health care. Geography and tradition play a big part in determining where one goes—or ϊ/one goes—for health care in Tennessee. We then compiled information on the locations of health care providers— the physicians, hospitals, primary care centers, and so forth, and in every county examined ratios of primary care physicians to residents. We looked at statistics on virtually every health issue. The Indigent Care Cabinet Council examined all this information and listened to testimony from citizens across the state. The council concluded that major efforts were needed to improve the accessibility, availability, and affordability of health care services in Tennessee. Specific strategies have been developed for action in each of these areas. Accessibility First, let's look at accessibility. In one of its first actions, the McWherter administration worked with hospitals two years ago to enact a disproportionate share adjustment program that would provide financial assistance to hospitals serving large numbers of Medicaid and indigent care patients. This program, which currently has a total budget of around $85 million, has been important in helping hospitals meet some of the uncompensated costs that they incur as they serve low-income Tennesseans. More recently, this spring, the Tennessee General Assembly passed the Community Health Agency Act of 1989, which provides for setting up regional mechanisms called Community Health Agencies (CHAs) throughout the state to help coordinate health care services for indigent persons. The Cabinet Council's first conclusion was that no single agency, public or private, had the responsibility for providing services to the indigent and underserved. These Community Health Agencies will act as "brokers" between the private and public sectors and may, as a last resort, provide health...