American College of Physicians: Internal Medicine — Doctors for Adults ®

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Study seeks data on how internists treat the uninsured

From the February ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

When your patients lose their health insurance, are you still able to treat them in your office? Do you have different referral patterns for insured and uninsured patients, and do you think your uninsured patients' health is at risk?

Those are just a few of the questions that ACP-ASIM hopes to answer through a two-year collaborative study with the New York Academy of Medicine, a Manhattan-based nonprofit educational and research institution that focuses on care of the urban poor. The project will be funded by a $60,000 grant from the ACP-ASIM Foundation plus donated ACP-ASIM staff time, and by a $70,000 grant from the Commonwealth Fund.

The study will try to identify how practicing internists across the country treat uninsured patients, in part by surveying physicians in private practice about what they can—and cannot—do to care for the uninsured.

"We expect to get some very good information about the challenges and barriers that physicians in private practice face when caring for the uninsured," said Jack Ginsburg, the College's Director of Health Policy and Analysis and project manager for the study. "We also want to learn the strategies physicians use when treating patients who lack the resources to pay for care."

ACP-ASIM officials hope the survey results, which are expected later this year, will help their advocacy efforts for better access to care for the uninsured. The College also wants to learn how the barriers facing the uninsured affect members' morale and job satisfaction.

Gerry Fairbrother, PhD, a senior researcher at the New York Academy who will serve as the study's co-principal investigator, said she hopes the findings will also help change the public's attitudes. "Polls show that the majority of Americans still think there is basically no problem, that the uninsured are able to get the care they need," she explained. "If the public finds out that there is a problem, they may be more inclined to do something about it."

The survey will be sent this spring to nearly 1,500 College members who are primary care physicians in private solo or group practice. Physicians will be chosen randomly from 10 states: California, Colorado, Idaho, Massachusetts, Michigan, Missouri, Pennsylvania, South Carolina, Texas and West Virginia.

Dr. Fairbrother's team will also survey "safety net" institutions in those states. The goal will be to compare how the uninsured are cared for by physicians in private practice versus physicians working in public hospitals and community health centers.

The survey is the College's latest effort to educate the American public about the problems of not having health care coverage. As part of the ACP-ASIM's Decision 2000 campaign, the College released a series of reports detailing the health effects of lacking access to health care. The College has also worked with legislators to push for better access to care. (More information is online at www.acponline.org/hpp/menu/access.htm.)

For more information on the study, contact Jack Ginsburg at jginsburg@mail.acponline.org or 800-338-2746.

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