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January 12, 1990, Vol 263, No. 2 >
ARTICLE | January 12, 1990

Local Advocacy for the Medically Indigent: Title and subTitle BreakStrategies and Accomplishments in One County FREE

Vicki Mayster, MA; Howard Waitzkin, MD, PhD; F. Allan Hubbell, MD, MSPH; Lloyd Rucker, MD
[+] Author Affiliations

Reprint requests to University of California, Irvine/ North Orange County Community Clinic, 300 W RomneyaDr, Anaheim, CA92801 (Dr Waitzkin).


JAMA. 1990;263(2):262-268. doi:10.1001/jama.1990.03440020096040
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References

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved shortterm investigations of barriers to needed services so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence state and national policies that affect local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system that guarantees access, they can substantially improve the availability of local services.

(JAMA. 1990;263:262-268)

REFERENCES

1 +
Freeman HE, Blendon RJ, Aiken LH, Sudman S, Mullinix CF, Corey CR.  Americans report on their access to health care . Health Aff. 1987;;6:6-18.
2 +
Davis JE.  National initiatives for care of the medically needy . JAMA . 1988;;259:3171-3173.
3 +
Kellermann AL, Hackman BB.  Emergency department patient 'dumping': an analysis of interhospital transfers to the regional medical center at Memphis, Tennessee . Am J Public Health . 1988;;78:1287-1292.
4 +
Schiff RL, Ansell DA, Schlosser JE, Idris AH, Morrison A, Whitman S.  Transfers to a public hospital: a prospective study of 467 patients . N Engl J Med. 1986;;314:552-557.
5 +
Reed WG, Cawley KA, Anderson RJ.  The effect of a public hospital's transfer policy on patient care . N Engl J Med. 1986;;22:1428-1432.
6 +
Brown ER, Burciaga Valdez R, Morgenstern H, Bradley T, Hafner C. Californians Without Health Insurance: A Report to the California Legislature . Berkeley: California Policy Seminar, University of California; 1987;.
7 +
Brown ER, Cousineau MR. Assessing Indigent Health Care Needs and Use of County Health Services . Berkeley: California Policy Seminar, University of California; 1987;.
8 +
The California Dream, the California Nightmare: 5.2 Million People With No Health Insurance . San Francisco, Calif: Health Access; 1988;.
9 +
Braveman P, Oliva G, Miller MG, Reiter R, Egerter S.  Adverse outcomes and lack of health insurance in an eight-county area of California, 1982 to 1986 . N Engl J Med. 1989;;321:508-513.
10 +
Mandelblatt JS, Adler RS, Bennett NM, Fein OT, Hoffman S, Mattimore TJ.  Divisions of general medicine: ambulatory care activities and responses to cost containment . J Gen Intern Med. 1987;;2:388-393.
11 +
Gates-Williams J, Schear S, Tervalon M.  Health care administration and the county hospital: community activism as a catalyst for change . J Health Hum Resources Admin. 1988;;10:297-310.
12 +
Lazarus W, Tirengel J. Back to Basics 1988: Strategies for Investing in the Health of California's Next Generation . Santa Monica: Southern California Child Health Network; 1988;.
13 +
McElmurry BJ, Swider SM, Grimes MJ, Dan AJ, Irvin YS, Lourenco SV.  Health advocacy for young, low-income, inner-city women . Adv Nurs Sci. 1987;;9:62-75.
14 +
Freudenberg N, Golub M.  Health education, public policy and disease prevention: a case history of the New York City Coalition to End Lead Poisoning . Health Educ Q. 1987;;14:387-401.
15 +
Turner TA.  The role of advocacy organizations . NLN Publ. 1988;;20:351-361.
16 +
Orange County Administrative Office. Orange County Mid-Decade Demographic Survey . Santa Ana, Calif: County of Orange; 1986;.
17 +
California Dept of Finance. Current Population Survey . Sacramento: State of California; 1986;.
18 +
California State Census Data Center. Current Population Report . Sacramento: State of California; 1988;.
19 +
Current Population Reports: Poverty in the U.S.: 1987 . Washington, DC: US Bureau of the Census; 1989;.
20 +
Report . Santa Ana, Calif: Orange County Coalition for the Homeless; 1985;.
21 +
Impact of Immigration Reform and Control Act: The Orange County Experience . Santa Ana, Calif: Hispanic Development Council of United Way of Orange County and Orange County Human Relations Commission; 1989;.
22 +
The Effects of Competition and Deregulation on the Health Care Delivery System in Orange County With Particular Emphasis on the Indigent Population . Tustin, Calif: Orange County Health Planning Council; 1985;.
23 +
Health Task Force. Orange County's Health Care Crisis: A Societal Dimensions Report . Garden Grove, Calif: United Way of Orange County; 1987;.
24 +
 Fair market rent . Federal Register . (December 21) , 1987;;52:48210.
25 +
Waitzkin H.  Two-class medicine returns to the United States: impact of Medi-Cal reform . Lancet . 1984;;2:1144-1146.
26 +
Bergthold L.  Crabs in a bucket: the politics of health care reform in California . J Health Polit Policy Law . 1984;;9:203-222.
27 +
Perloff JD, Neckerman K, Kletke PR.  Pediatrician participation in Medicaid: findings of a five-year follow-up study in California and elsewhere . West J Med. 1986;;145:546-550.
28 +
Perloff JD, Neckerman K, Kletke PR.  Physicians' decisions to limit Medicaid participation: determinants and policy implications . J Health Polit Policy Law. 1987;;12:221-235.
29 +
IMS Program Brochure . Santa Ana, Calif: Orange County Health Care Agency; 1986;.
30 +
Waitzkin H.  The return of two-class medicine: ill effects of Medi-Cal reform . West J Med. 1985;;142:708-709.
31 +
Akin BV, Rucker L, Hubbell FA, Cygan RC, Waitzkin H.  Access to medical care in a medically indigent population . J Gen Intern Med. 1989;;4:216-220.
32 +
Hubbell FA, Waitzkin H, Rucker L, Akin BV, Heide MG.  Financial barriers to medical care: a prospective study in a university-affiliated community clinic . Am J Med Sci. 1989;;297:158-162.
33 +
Hubbell FA, Waitzkin H, Mishra SI, Dombrink J.  Evaluating health-care needs of the poor: a community-oriented approach . Am J Med. 1989;;87:127-131.
34 +
Indigent Medical Services Office. Medical Services Program Summary Statistics for FY1985-86 and FY 1986-87 . Santa Ana, Calif: Orange County Health Care Agency; 1986, 1987;.
35 +
Waitzkin H, Akin BV, de la Maza LM, et al.  Deciding against corporate management of an academic medical center . N Engl J Med. 1986;;315: 1299-1304.
36 +
Waitzkin H.  Why it's time for a national health program in the United States . West J Med. 1989;;150:101-107.
37 +
Himmelstein DU, Woolhandler S, and the Writing Committee of the Working Group on Program Design, Physicians for a National Health Program.  A national health program for the United States: a physician's proposal . N Engl J Med. 1989;;320:102-108.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Freeman HE, Blendon RJ, Aiken LH, Sudman S, Mullinix CF, Corey CR.  Americans report on their access to health care . Health Aff. 1987;;6:6-18.
2 +
Davis JE.  National initiatives for care of the medically needy . JAMA . 1988;;259:3171-3173.
3 +
Kellermann AL, Hackman BB.  Emergency department patient 'dumping': an analysis of interhospital transfers to the regional medical center at Memphis, Tennessee . Am J Public Health . 1988;;78:1287-1292.
4 +
Schiff RL, Ansell DA, Schlosser JE, Idris AH, Morrison A, Whitman S.  Transfers to a public hospital: a prospective study of 467 patients . N Engl J Med. 1986;;314:552-557.
5 +
Reed WG, Cawley KA, Anderson RJ.  The effect of a public hospital's transfer policy on patient care . N Engl J Med. 1986;;22:1428-1432.
6 +
Brown ER, Burciaga Valdez R, Morgenstern H, Bradley T, Hafner C. Californians Without Health Insurance: A Report to the California Legislature . Berkeley: California Policy Seminar, University of California; 1987;.
7 +
Brown ER, Cousineau MR. Assessing Indigent Health Care Needs and Use of County Health Services . Berkeley: California Policy Seminar, University of California; 1987;.
8 +
The California Dream, the California Nightmare: 5.2 Million People With No Health Insurance . San Francisco, Calif: Health Access; 1988;.
9 +
Braveman P, Oliva G, Miller MG, Reiter R, Egerter S.  Adverse outcomes and lack of health insurance in an eight-county area of California, 1982 to 1986 . N Engl J Med. 1989;;321:508-513.
10 +
Mandelblatt JS, Adler RS, Bennett NM, Fein OT, Hoffman S, Mattimore TJ.  Divisions of general medicine: ambulatory care activities and responses to cost containment . J Gen Intern Med. 1987;;2:388-393.
11 +
Gates-Williams J, Schear S, Tervalon M.  Health care administration and the county hospital: community activism as a catalyst for change . J Health Hum Resources Admin. 1988;;10:297-310.
12 +
Lazarus W, Tirengel J. Back to Basics 1988: Strategies for Investing in the Health of California's Next Generation . Santa Monica: Southern California Child Health Network; 1988;.
13 +
McElmurry BJ, Swider SM, Grimes MJ, Dan AJ, Irvin YS, Lourenco SV.  Health advocacy for young, low-income, inner-city women . Adv Nurs Sci. 1987;;9:62-75.
14 +
Freudenberg N, Golub M.  Health education, public policy and disease prevention: a case history of the New York City Coalition to End Lead Poisoning . Health Educ Q. 1987;;14:387-401.
15 +
Turner TA.  The role of advocacy organizations . NLN Publ. 1988;;20:351-361.
16 +
Orange County Administrative Office. Orange County Mid-Decade Demographic Survey . Santa Ana, Calif: County of Orange; 1986;.
17 +
California Dept of Finance. Current Population Survey . Sacramento: State of California; 1986;.
18 +
California State Census Data Center. Current Population Report . Sacramento: State of California; 1988;.
19 +
Current Population Reports: Poverty in the U.S.: 1987 . Washington, DC: US Bureau of the Census; 1989;.
20 +
Report . Santa Ana, Calif: Orange County Coalition for the Homeless; 1985;.
21 +
Impact of Immigration Reform and Control Act: The Orange County Experience . Santa Ana, Calif: Hispanic Development Council of United Way of Orange County and Orange County Human Relations Commission; 1989;.
22 +
The Effects of Competition and Deregulation on the Health Care Delivery System in Orange County With Particular Emphasis on the Indigent Population . Tustin, Calif: Orange County Health Planning Council; 1985;.
23 +
Health Task Force. Orange County's Health Care Crisis: A Societal Dimensions Report . Garden Grove, Calif: United Way of Orange County; 1987;.
24 +
 Fair market rent . Federal Register . (December 21) , 1987;;52:48210.
25 +
Waitzkin H.  Two-class medicine returns to the United States: impact of Medi-Cal reform . Lancet . 1984;;2:1144-1146.
26 +
Bergthold L.  Crabs in a bucket: the politics of health care reform in California . J Health Polit Policy Law . 1984;;9:203-222.
27 +
Perloff JD, Neckerman K, Kletke PR.  Pediatrician participation in Medicaid: findings of a five-year follow-up study in California and elsewhere . West J Med. 1986;;145:546-550.
28 +
Perloff JD, Neckerman K, Kletke PR.  Physicians' decisions to limit Medicaid participation: determinants and policy implications . J Health Polit Policy Law. 1987;;12:221-235.
29 +
IMS Program Brochure . Santa Ana, Calif: Orange County Health Care Agency; 1986;.
30 +
Waitzkin H.  The return of two-class medicine: ill effects of Medi-Cal reform . West J Med. 1985;;142:708-709.
31 +
Akin BV, Rucker L, Hubbell FA, Cygan RC, Waitzkin H.  Access to medical care in a medically indigent population . J Gen Intern Med. 1989;;4:216-220.
32 +
Hubbell FA, Waitzkin H, Rucker L, Akin BV, Heide MG.  Financial barriers to medical care: a prospective study in a university-affiliated community clinic . Am J Med Sci. 1989;;297:158-162.
33 +
Hubbell FA, Waitzkin H, Mishra SI, Dombrink J.  Evaluating health-care needs of the poor: a community-oriented approach . Am J Med. 1989;;87:127-131.
34 +
Indigent Medical Services Office. Medical Services Program Summary Statistics for FY1985-86 and FY 1986-87 . Santa Ana, Calif: Orange County Health Care Agency; 1986, 1987;.
35 +
Waitzkin H, Akin BV, de la Maza LM, et al.  Deciding against corporate management of an academic medical center . N Engl J Med. 1986;;315: 1299-1304.
36 +
Waitzkin H.  Why it's time for a national health program in the United States . West J Med. 1989;;150:101-107.
37 +
Himmelstein DU, Woolhandler S, and the Writing Committee of the Working Group on Program Design, Physicians for a National Health Program.  A national health program for the United States: a physician's proposal . N Engl J Med. 1989;;320:102-108.

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