Traditionally, medical care for the uninsured and underserved has been provided by a combination of public and non-profit health care organizations. Funding for these organizations has primarily come from federal, state, and local budgets. Over the last 10 years, state funding has increased to replace federal funding for these services. Despite these funding changes, the availability and adequacy of resources has not kept pace with the needs of providers to the uninsured and underserved populations. Many non-profit providers are less able to fund charity care because of declining payments from government and insurance funders.

Impact
Providers serving low-income, uninsured, and underserved populations struggle to deliver basic health care while dealing with large numbers of patients, complicated financial issues, inadequate staffing, and little or no resource development. As more adults work in jobs that offer either unaffordable health insurance or no insurance at all, the numbers of patients primary care providers to the poor serve continues to grow, straining the already limited resources.

If providers to the poor have the opportunity to develop the resources that keep them competitive, not only do the providers increase their sustainability, the community also benefits. The quality of care increases as the providers utilize available resources and collaborate with other providers to share these resources and ideas. As practices improve, the health of the community improves, reducing the number of work and school days missed because of illness.

Our Service Region
In the Foundation's service area, about 13% of the population is uninsured. In some counties and neighborhoods the percentage of the population with no insurance can reach as high as 18%. Health clinics in disadvantaged neighborhoods are seeing an increase in the number of uninsured people using their services. At some clinics, over 40% of new patients are uninsured. In addition, thirteen of the 20 counties in the Foundation's service are designated in whole or part as Health Professional Shortage Areas (HPSA), which means the ratio of health care professionals to population is extremely low.

Community Primary Care Advisory Group
The Health Foundation convened an Advisory Group of primary care providers and social service experts in 1998 to assist in understanding the status of primary care services for the uninsured and underserved people in our region. This Advisory Group also helped the Foundation develop two strategies to target funding toward strengthening primary care providers for the poor in ways that the community needs most.