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Access to Care Outcomes: A Telephone Interview Study of a Suburban Safety Net Program for the Uninsured

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Abstract

Access DuPage (AD) currently provides primary care for about 14,000 low income, uninsured residents of suburban DuPage County, IL, an area with a very limited healthcare safety net infrastructure. A telephone interview survey evaluated health care utilization, satisfaction, and health status outcomes and compared recent enrollees to individuals in the program for at least 1 year. Sequential new AD enrollees (n = 158) were asked about the previous year when uninsured, while randomly selected established AD enrollees (n = 135) were asked the same questions about the previous year when actively enrolled in AD. Established enrollees reported being more likely to get ‘any kind of tests or treatment’ (96.3 vs. 46.2 %, p < 0.0001), fewer cost (78.5 vs. 21.3 %, p < 0.0001) and transportation barriers to care, more preventive and mental health services, and better self-management care. However, established enrollees also reported 14 % greater use of hospital inpatient and 9 % greater use of emergency room care, as well as continued difficulty in accessing needed specialty and dental care services. Despite more (diagnosed) conditions, established enrollees were over 2.5 times more likely to report good to excellent health status and over three times more likely to rate their satisfaction with health care as good to excellent. Findings illustrate the substantial benefits of assuring access to care for the uninsured, but do not reflect immediate savings from reduced hospital utilization. Access to care programs will be an important tool to address the needs of the 30 million people who will continue to be uninsured in the United States.

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Acknowledgments

We would like to acknowledge Carol Tritschler, Jesus Alvarez, Nadia Hajjar, Shaneah Taylor, Jennifer Neimeyer PhD, Yessica Cabrera, Jorge Cabrera, Elizabeth Cabrera, Megan Hannan, Brittany Linstrot, Anh Hien Chung, Samantha Torres, Mohammed Deeb, Belinda Reyes, and Dora Monroe for their invaluable assistance with telephone interviews, data processing, and research assistance for this project. This work was supported by a seed Grant from the Northwestern University Alliance for Research in Chicagoland Communities. All authors were also funded by grant R24 MD001650 from the National Institute for Minority Health and Health Disparities.

Conflict of interest

No potential conflicts of interest were disclosed.

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Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL, 60611, USA

    Joe Feinglass

  2. Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Narissa J. Nonzee

  3. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA

    Narissa J. Nonzee

  4. Access DuPage, Carol Stream, IL, USA

    Kara R. Murphy & Richard Endress

  5. Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Melissa A. Simon

  6. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Melissa A. Simon

  7. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Melissa A. Simon

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  1. Joe Feinglass
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  2. Narissa J. Nonzee
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  3. Kara R. Murphy
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  4. Richard Endress
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  5. Melissa A. Simon
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Correspondence to Joe Feinglass.

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Feinglass, J., Nonzee, N.J., Murphy, K.R. et al. Access to Care Outcomes: A Telephone Interview Study of a Suburban Safety Net Program for the Uninsured. J Community Health 39, 108–117 (2014). https://doi.org/10.1007/s10900-013-9746-1

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  • DOI: https://doi.org/10.1007/s10900-013-9746-1

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