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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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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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  1. Berube, A., & Keebone, E. (2006). Two steps back: City and suburban poverty trends 1999–2005 living cities census series (pp. 1–23). Washington, DC: Brookings Institution.

    Google Scholar 

  2. American Community Survey. (2013, July 2). Retrieved July 5, 2013, from

  3. Illinois Behavioral Risk Factor Surveillance System. (2012, November 20). Retrieved April 23, 2013, from

  4. Center for Disease Control and Prevention. (2011). CDC Health disparities and inequalities report—United States, 2011. MMWR 2011 (Vol. 60, pp. 1–113).

  5. National Study of Latinos. (2004). Washington, DC: Pew Hispanic Center/Kaiser Family Foundation. Retrieved May 8, 2013, from

  6. Access DuPage. (2012). Retrieved July 8, 2013, from

  7. Behavioral Risk Factor Surveillance System. (2013, March 10). Retrieved April 23, 2013, from

  8. Consumer Assessment of Health Providers and Systems (CAHPS). (n.d.). Retrieved April 23, 2013, from

  9. Aragones, A., Schaefer, E. W., Stevens, D., Gourevitch, M. N., Glasgow, R. E., & Shah, N. R. (2008). Validation of the Spanish translation of the Patient Assessment of Chronic Illness Care (PACIC) survey. Preventing Chronic Disease, 5(4), A113.

    PubMed Central  PubMed  Google Scholar 

  10. Glasgow, R. E., Wagner, E. H., Schaefer, J., Mahoney, L. D., Reid, R. J., & Greene, S. M. (2005). Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Medical Care, 43(5), 436–444.

    Article  PubMed  Google Scholar 

  11. Sudano, J. J., Jr, & Baker, D. W. (2003). Intermittent lack of health insurance coverage and use of preventive services. American Journal of Public Health, 93(1), 130–137.

    Article  PubMed  Google Scholar 

  12. Sommers, B. D., Baicker, K., & Epstein, A. M. (2012). Mortality and access to care among adults after state Medicaid expansions. New England Journal of Medicine, 367(11), 1025–1034. doi:10.1056/NEJMsa1202099.

    Article  CAS  PubMed  Google Scholar 

  13. Baker, D. W., Feinglass, J., Durazo-Arvizu, R., Witt, W. P., Sudano, J. J., & Thompson, J. A. (2006). Changes in health for the uninsured after reaching age-eligibility for Medicare. Journal of General Internal Medicine, 21(11), 1144–1149. doi:10.1111/j.1525-1497.2006.00576.x.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Baker, D. W., Sudano, J. J., Durazo-Arvizu, R., Feinglass, J., Witt, W. P., & Thompson, J. (2006). Health insurance coverage and the risk of decline in overall health and death among the near elderly, 1992–2002. Medical Care, 44(3), 277–282. doi:10.1097/01.mlr.0000199696.41480.45.

    Article  PubMed  Google Scholar 

  15. McWilliams, J. M., Meara, E., Zaslavsky, A. M., & Ayanian, J. Z. (2007). Use of health services by previously uninsured Medicare beneficiaries. New England Journal of Medicine, 357(2), 143–153. doi:10.1056/NEJMsa067712.

    Article  CAS  PubMed  Google Scholar 

  16. Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J., et al. (2013). The Oregon experiment—Effects of Medicaid on clinical outcomes. New England Journal of Medicine, 368(18), 1713–1722. doi:10.1056/NEJMsa1212321.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Finkelstein, A., Taubman, S., Wright, B., Bernstein, M., Gruber, J., Newhouse, J., et al. (2012). The Oregon health insurance experiment: Evidence from the first year. The Quarterly Journal of Economics, 127(3), 1057–1106.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ahmed, S. M., & Maurana, C. A. (2000). Reaching out to the underserved: a successful volunteer program. American Journal of Public Health, 90(3), 439–440.

    Article  CAS  PubMed  Google Scholar 

  19. Blewett, L. A., Ziegenfuss, J., & Davern, M. E. (2008). Local access to care programs (LACPs): New developments in the access to care for the uninsured. Milbank Quarterly, 86(3), 459–479. doi:10.1111/j.1468-0009.2008.00529.x.

    Article  PubMed  Google Scholar 

  20. Taylor, E. F., Cunningham, P., & McKenzie, K. (2006). Community approaches to providing care for the uninsured. Health Affairs, 25(3), w173–w182. doi:10.1377/hlthaff.25.w173.

    Article  PubMed  Google Scholar 

  21. Uhlig, P. N. (2000). A call to leadership: Project access—Helping the uninsured community by community. Annals of Thoracic Surgery, 70(2), 354–355.

    Article  CAS  PubMed  Google Scholar 

  22. McDonald, E. M., Frattaroli, S., Edsall Kromm, E., Ma, X., Pike, M., & Holtgrave, D. (2012). Improvements in health behaviors and health status among newly insured members of an innovative health access plan. Journal of Community Health,. doi:10.1007/s10900-012-9615-3.

    Google Scholar 

  23. Cunningham, P., & Hadley, J. (2004). Expanding care versus expanding coverage: How to improve access to care. Health Affairs, 23(4), 234–244.

    Article  PubMed  Google Scholar 

  24. Feinglass, J., Lin, S., Thompson, J., Sudano, J., Dunlop, D., Song, J., et al. (2007). Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: Findings from the Health and Retirement Study, 1992 2002. Journals of Gerontology, 62(4), S209–S217.

    Article  PubMed  Google Scholar 

  25. Ferraro, K. F., & Kelley-Moore, J. A. (2001). Self-rated health and mortality among black and white adults: Examining the dynamic evaluation thesis. Journals of Gerontology, 56(4), S195–S205.

    Article  CAS  PubMed  Google Scholar 

  26. Harvey, L., Fowles, J. B., Xi, M., & Terry, P. (2012). When activation changes, what else changes? The relationship between change in patient activation measure (PAM) and employees’ health status and health behaviors. Patient Education and Counseling, 88(2), 338–343. doi:10.1016/j.pec.2012.02.005.

    Article  PubMed  Google Scholar 

  27. Mosen, D. M., Schmittdiel, J., Hibbard, J., Sobel, D., Remmers, C., & Bellows, J. (2007). Is patient activation associated with outcomes of care for adults with chronic conditions? The Journal of Ambulatory Care Management, 30(1), 21–29.

    Article  PubMed  Google Scholar 

  28. MacKinney, T., Visotcky, A. M., Tarima, S., & Whittle, J. (2013). Does providing care for uninsured patients decrease emergency room visits and hospitalizations? Journal of Primary Care & Community Health, 4(2), 135–142.

    Article  Google Scholar 

  29. Bradley, C. J., Gandhi, S. O., Neumark, D., Garland, S., & Retchin, S. M. (2012). Lessons for coverage expansion: a Virginia primary care program for the uninsured reduced utilization and cut costs. Health Affairs, 31(2), 350–359. doi:10.1377/hlthaff.2011.0857.

    Article  PubMed  Google Scholar 

  30. Hall, M. A., Hwang, W., & Jones, A. S. (2011). Model safety-net programs could care for the uninsured at one-half the cost of Medicaid or private insurance. Health Affairs, 30(9), 1698–1707. doi:10.1377/hlthaff.2010.0946.

    Article  PubMed  Google Scholar 

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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.

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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).

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