UTHealth Researchers Predict Major Challenges for Houston Safety Net Providers Under Health Reform

HOUSTON, March 26 -- The University of Texas System Health Science Center at Houston issued the following news release:

Safety net providers in the Houston-Harris County area lack the primary care capacity to meet a projected surge in demand once the Patient Protection and Affordable Care Act (ACA) is fully implemented, according to researchers at The University of Texas Health Science Center at Houston (UTHealth).

"With the anticipated expansion of Medicaid coverage under the health reform act, demand for primary care could increase by 30 percent by residents which includes the low-income population, leading to a drop in the ability to provide service by safety net providers," said Charles Begley, Ph.D., professor of management, policy and community health at the UT School of Public Health, a part of UTHealth. Findings from Begley's research are published in the most recent issue of the Journal of Health Care for the Poor and Underserved.

The health care safety net includes public and private health care providers that either voluntarily or because of emergency circumstances provide medical care services at discounted rates to the uninsured, underinsured, Medicaid, and/or indigent patients.

The safety net is currently meeting about 30 percent of the demand for primary care visits by the low-income population and the rest is either met by private practice physicians or is left unmet. Begley anticipates that safety net providers will only be able to meet 25 percent of the demand under the ACA.

"It is important to be concerned because a shortage of primary care leads to more people experiencing serious illness requiring expensive specialty care, emergency services and hospitalization," said Begley.

According to the study, longer wait times for new patient appointments at safety net clinics and a decrease in the number of physicians willing to treat Medicaid and uninsured patients are already contributing to the current unmet primary care needs in the low-income population. In addition, Begley adds there is a lack of knowledge of local primary care resources available to the low-income population, driving many to seek primary care services in the emergency departments.

Safety net clinics that provide primary care services were surveyed using the Project Safety Net Clinic Survey developed by St. Luke's Episcopal Health Charities. Researchers calculated the total visits demanded by the low-income population with and without health reform, and compared the number to the actual visits provided by the safety net.

"The big question everyone is wondering is to what extent the newly insured residents under health reform will rely on safety net providers once they gain access to private providers," said Begley. "There are not enough primary care providers in the area to meet the new demand of those who will have access to care under the ACA."

To meet the full demand of service by 2019, the local safety net would need to increase primary care service capacity by approximately 17 to 18 percent per year. To maintain the current demand met, the safety net would still need to grow by 2 to 3 percent per year.

If fully implemented, the act's mandates of Medicaid expansions, subsidized insurance premiums and other reforms are expected to reduce the number of uninsured by over 30 million people nationwide by 2019.

Begley points to the 2006 Massachusetts health reform, in which the safety net providers in the state played a critical role in caring for newly insured patients while also serving as the primary care safety net for remaining uninsured residents. "If Texas unfolds like Massachusetts, our findings suggest a growing deficit in the percentage of primary care demand of the low-income population met by safety net providers under health care reform," said Begley.

According to the report, some efforts have been recently implemented by safety net providers in response to the growing number of uninsured. Those include coordinated pursuit of public and private funding, expanding the capacity of primary care providers and efforts to organize services. "More coordinated efforts of public and private safety net providers are needed to expand primary care capacity in the local area in preparation of what will come once the ACA is fully implemented," said Begley.

Begley adds that more research is needed to assess the capacity of the private practice physicians to serve this population and to respond to the increase in demand for primary care under health reform. "This information is needed to understand the possible challenges we will face in primary care and to pinpoint the need for expansions to avoid increased waiting times and access to care," he said.

Other researchers include Phuc Le, M.P.H. a doctoral candidate at the UT School of Public Health; David Lairson, Ph.D., professor of management, policy and community health at the UT School of Public Health; Jeanne Hanks, Dr.P.H., community liaison at St. Luke's Episcopal Health Charities and director of the Project Safety Net Survey; and Anthony Omojasola, Dr.P.H. chief operating officer of Park DuValle Community Health Center in Louisville, Kentucky.

This research was funded by the Houston Endowment.

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