Felland Laurie E, Lauer Johanna R, Cunningham Peter J
Res Brief. 2009 Jul(13):1-12.
Although suburban poverty has increased in the past decade, the availability of health care services for low-income and uninsured people in the suburbs has not kept pace. According to a new study by the Center for Studying Health System Change (HSC) of five communities--Boston, Cleveland, Indianapolis, Miami and Seattle--low-income people living in suburban areas face significant challenges accessing care because of inadequate transportation, language barriers and lack of awareness of health care options. Low-income people often rely on suburban hospital emergency departments (EDs) and urban safety net hospitals and health centers. Some urban providers are feeling the strain of caring for increasing numbers of patients from both the city and the suburbs. Both urban and suburban providers are attempting to redirect patients to more appropriate care near where they live by expanding primary care capacity, improving access to specialists, reducing transportation challenges, and generating revenues to support safety net services. Efforts to improve safety net services in suburban areas are hampered by greater geographic dispersion of the suburban poor and jurisdictional issues in funding safety net services. To improve the suburban safety net, policy makers may want to consider flexible and targeted approaches to providing care, regional collaboration to share resources, and geographic pockets of need when allocating resources for community health centers and other safety net services and facilities.
尽管在过去十年里郊区贫困有所增加，但郊区为低收入和未参保人群提供的医疗服务却未能跟上步伐。根据医疗系统变革研究中心（HSC）对波士顿、克利夫兰、印第安纳波利斯、迈阿密和西雅图五个社区的一项新研究，居住在郊区的低收入人群在获得医疗服务方面面临重大挑战，原因包括交通不便、语言障碍以及对医疗选择缺乏了解。低收入人群往往依赖郊区医院的急诊科以及城市安全网医院和医疗中心。一些城市医疗服务提供者感受到了照顾来自城市和郊区越来越多患者的压力。城市和郊区的医疗服务提供者都在尝试通过扩大初级医疗服务能力、改善专科医生的可及性、减少交通挑战以及创收以支持安全网服务，将患者引导至他们居住地附近更合适的医疗机构。改善郊区安全网服务的努力受到郊区贫困人口地理分布更广以及安全网服务资金方面管辖权问题的阻碍。为了改善郊区安全网，政策制定者或许可以考虑采用灵活且有针对性的医疗服务提供方式、区域合作以共享资源，以及在为社区健康中心和其他安全网服务及设施分配资源时考虑有需求的地理区域。
