Gardner Annette, Kahn James G
Institute for Health Policy Studies, University of California, San Francisco, USA.
J Health Care Poor Underserved. 2006 Nov;17(4):830-50. doi: 10.1353/hpu.2006.0123.
We interviewed California county health agency staff and administered a 58-county survey in 2002 and 2004 to inventory programs designed to improve access to care for the uninsured, and to assess county ability to meet the needs of California's uninsured during slow economic periods. Most counties have established means to connect people to existing public insurance programs and services have been expanded. Growth in new health care insurance programs for children and modest growth for adults are apparent. Counties pursue funding opportunities by a variety of strategies (e.g., leveraging of existing funding to secure new funds such as federal Healthy Community Access Program (HCAP) grants). While counties vary in their resources, political will, and barriers to care, they share a strong commitment to access to care. The implications of local efforts for state and federal policymaking are significant. In the absence of federal or state reform, county initiatives, particularly children's coverage expansions, may coalesce into state-level reform. Second, the state may move closer to access to health care for all as it recognizes the complementarity of county programs.
2002年和2004年，我们采访了加利福尼亚州各县卫生机构的工作人员，并对58个县进行了调查，以清点旨在改善未参保者获得医疗服务机会的项目，并评估各县在经济低迷时期满足加利福尼亚州未参保者需求的能力。大多数县已建立了将人们与现有的公共保险项目相连接的方式，并且服务得到了扩展。儿童新医疗保险项目有所增长，成人项目也有适度增长。各县通过多种策略寻求资金机会（例如，利用现有资金来获取新资金，如联邦健康社区准入项目（HCAP）拨款）。虽然各县在资源、政治意愿和医疗服务障碍方面存在差异，但它们都坚定致力于提供医疗服务。地方努力对州和联邦政策制定具有重要意义。在缺乏联邦或州改革的情况下，县一级的举措，特别是儿童医保覆盖范围的扩大，可能会整合为州一级的改革。其次，随着该州认识到各县项目的互补性，它可能会朝着全民医疗服务的目标迈进。
