|
Increased private provider participation in public programs does not, however, increase the availability of care for people without insurance. According to the Center for Studying Health Systems Change, in 2005 less than 20% of urban primary care physicians nationwide provided more than 10 hours of free care per month, and 40% did not provide any free care. Further and ironically, increasing private care options for Medicaid patients is a double-edged sword, as it may have an unintended impact of diverting paying (Medicaid) patients from safety-net providers that offer free and reduced-price care to the uninsured. Many community and rural health centers rely on the Medicaid revenue stream to subsidize discounted care to uninsured Coloradans. Ensuring the financial viability of publicly supported clinics is vital to achieving access to care for low-income families, including the uninsured and publicly insured. With this in mind, The Trust balances investments in private sector approaches with efforts to strengthen safety-net provider capacity throughout the state. As well, The Trust recognizes that broader improvements in the health care system, such as covering the uninsured and provider payment reform, are ultimately necessary to ensure that an adequate network of public clinics and private providers exist to serve all Coloradans. Additional underserved children are receiving consistent primary, mental and dental health care thanks to the work of the Rocky Mountain Youth Clinics (RMYC). Through community clinics, mobile health care vans that serve rural and metro-area counties, and by establishing and servicing new school-based health centers, The Trust is supporting RMYC to provide care to uninsured and underinsured children in their communities. Additional funding to the Colorado Department of Public Health and Environment matches and leverages state funding to further increase and expand school-based health centers, and supports the School Health Leadership Task Force, which is working to create a comprehensive state plan to strengthen the system of integrated school health. A set of Trust grants also is supporting 14 diverse safety-net clinics, including faith-based clinics, school-based health centers, local public health departments and federally qualified health centers. By the end of the three-year grant period, these organizations anticipate that 18,000 children who do not now have access to health care will annually receive preventive, primary, oral and behavioral health care services. Expanding the capacity of the health care delivery system to care for a growing number of patients also requires addressing an increasing shortage inthe health professions workforce. Estimating that 17% of all health care workers in Colorado are expected to retire over the next decade, the Colorado Department of Labor and Employment forecasts shortages of physicians, nurses and other allied health professionals that will exacerbate existing workforce gaps in certain areas and create new ones. As shown on the graph below, based on projected physician retirements and future demand for services, the Colorado Health Institute (CHI) estimates that between 2005 and 2025 the shortage in Colorado will grow by an additional 1,500+ primary care physicians, with yet another 390 primary care physicians needed if health insurance coverage is expanded to include everyone. According to the Center for Research Strategies, sustaining an adequate workforce in the coming years will require shoring up the health professions "pipeline" (introduce young students to health professions careers, increase math and science education, and provide mentoring throughout the academic years and upon entering the workforce). Given the scope of the workforce shortage and the breadth of possible strategies to address the problem, The Trust convened the Colorado Health Professions Workforce Policy Collaborative. Comprised of representatives of hospitals, government agencies, research and policy organizations, educational institutions and health education centers, the Collaborative is researching health professions workforce challenges and opportunities, and developing a policy agenda to address workforce issues. Initial recommendations by this group include strengthening and expanding scopes of practice, increasing clinical placements, increasing funding for health professions education, expanding health professions workforce supply and demand data, and improving loan repayment opportunities.
|
