Mending the safety net: How doctors in some states are aiding those without care

Physicians are making up for gaps in federal and state health coverage by volunteering their time to help uninsured patients.

By Joel B. Finkelstein, AMNews staff. Nov. 3, 2003.

Rather than just watch a bad situation get worse, physicians are acting on the problem of the nation's uninsured.

New figures show that the ranks of the uninsured grew to 43.6 million in 2002. With more cuts to Medicaid expected, the weak economy persisting and little help from the federal government in sight, the problem is likely to get worse before it gets better, experts predict.

So doctors in many communities are trying to fill the void. With the help of state medical societies and social service agencies, these physicians have taken it upon themselves to tie together the frayed ends of the health care safety net, a patchwork of projects and institutions that provide medical care for the country's uninsured patients.

Those physicians who can still afford to are choosing to take a hit to their profit margins to continue providing charity care. Others are streamlining care for uninsured patients while finding they can improve relationships with the low-income patients they are already treating.

Programs adopted by physicians in three states provide insight into the types of strategies that are working for these communities.

In the mid-1990s, Delaware's Medicaid program took the managed care plunge. This resulted in slightly higher payment rates and greater physician participation, but ended the need for the Voluntary Initiative Program, which matched doctors with the state's neediest patients.

Rather than abandon the program altogether, physicians shifted their focus. They created VIP Phase II to address the growing needs of another population -- the working poor.