Local access to care programs (LACPs): new developments in the access to care for the uninsured.

CONTEXT: New, locally based health care access programs are emerging in response to the growing number of uninsured, providing an alternative to health insurance and traditional safety net providers. Although these programs have been largely overlooked in health services research and health policy, they are becoming an important local supplement to the historically overburdened safety net. METHODS: This article is based on a literature review, Internet search, and key actor interviews to document programs in the United States, using a typology to classify the programs and document key characteristics. FINDINGS: Local access to care programs (LACPs) fall outside traditional private and publicly subsidized insurance programs. They have a formal enrollment process, eligibility determination, and enrollment fees that give enrollees access to a network of providers that have agreed to offer free or reduced-price health care services. The forty-seven LACPs documented in this article were categorized into four general models: three-share programs, national-provider networks, county-based indigent care, and local provider-based programs. CONCLUSIONS: New, locally based health access programs are being developed to meet the health care needs of the growing number of uninsured adults. These programs offer an alternative to traditional health insurance and build on the tradition of county-based care for the indigent. It is important that these locally based, alternative paths to health care services be documented and monitored, as the number of uninsured adults is continuing to grow and these programs are becoming a larger component of the U.S. health care safety net.

State variation in SCHIP allocations: how much is there, what are its sources, and can it be reduced?

Allocations for the State Children's Health Insurance Program (SCHIP) varied 22% per state between 1999 and 2002. The funding fluctuations present significant problems for states as they develop budget priorities under difficult fiscal conditions. We examine sources of the variation in state allocations during the first four years of SCHIP, focusing on the Current Population Survey's "child component" of the allocation formula. We consider the trade-offs in using alternative estimates from the American Community Survey and model-based estimation. Obtaining reliable estimates of need for SCHIP allocations is critical for states dependent on federal support for insurance programs.

Education and the health professions: explaining policy choices among the states.

Recent calls for restructuring of the nation's health care system have highlighted the deficiencies in the current system of education for the health professions. Of particular concern are the dominance of specialization and hospital-based training and the tendency of new health care providers to settle in communities without substantial health needs. The states are the key actors in reforming health professions education, serving as a primary funding source for health professions schools, chief licensors and regulators of health professions, regulators of private health insurance, key providers of Medicaid, and architects of a variety of subsidy and regulatory programs providing incentives for health professionals to choose specialties and locations for practice. This article provides a taxonomy of state policies affecting health professions education reform and classifies the states according to the choices they have made. Findings show that few states take advantage of their policy options across the four policy types and that most tend to concentrate their efforts on a few policies--ignoring potential means of encouraging more primary care providers in underserved areas. Results from regression models explaining state choice of policy adoption highlight the political nature of policy choice and the highly variable nature of state response in health professions education reform.