Formal practice policies limiting care to uninsured patients were reported by 13 percent of responding faculty. Factors cited as barriers to care of the uninsured included the fact that few such patients were referred, inadequate reimbursement for services, and a sense that even in the absence of formal policies providing such care was discouraged by their practice or hospital.
The authors note that efforts to provide services for the uninsured must go beyond primary care, which is the usual focus of existing safety net programs. They also note that several currently available sources of reimbursement for care of the poor or uninsured including Medicare and Medicaid subsidies and state uncompensated care pools have traditionally been available only to hospitals and not to physician practice groups. Broadening the availability of such funds is a possible way to increase the availability of specialty services, they suggest.
"One also might ask what message it sends to residents in our teaching hospitals, when on the one hand they are being taught that care is provided regardless of the patient's financial condition and on the other hand they see the problems their teachers have obtaining needed services for their uninsured patients," adds Weissman.
Weissman's co-authors are David Blumenthal, MD, MPP, director of the MGH Institute for Health Policy; Eric Campbell, PhD, Manjusha Gokhale, Recai Yucel, PhD, and Nancyanne Causino, EdD, all of the MGH Institute for Health Policy; and Ernest Moy, MD, of the Agency for Healthcare Research and Quality Center for Quality Improvement and Patient Safety. The research was supported by The Commonweath Fund, The Pew Charitable Trusts, Burroughs Wellcome and the Doris Duke Charitable Foundation.
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Contact: Sue McGreevey
smcgreevey@partners.org
617-724-2764
Massachusetts General Hospital
12-Nov-2003