Hall Mark A
Department of Social Science and Health Policy at Wake Forest University, Winston- Salem, NC 27157, USA.
J Health Care Poor Underserved. 2013 May;24(2):741-52. doi: 10.1353/hpu.2013.0076.
Arranging referrals for specialist services is often the greatest difficulty that safety-net access programs face in attempting to provide fairly comprehensive services for the uninsured. When office-based community specialists are asked to care for uninsured patients, they cite the following barriers: difficulty determining which patients merit charity care, having to arrange for services patients need from other providers, and concerns about liability for providing inadequate care. Solutions to these barriers to specialist access can be found in the same institutional arrangements that support primary care and hospital services for the uninsured. These safety-net organization structures can be extended to include specialist physician care by funding community health centers to contract for specialist referrals, using free-standing referral programs to subsidize community specialists who accept uninsured patients at discounted rates, and encouraging hospitals through tax exemption or disproportionate share funding to require specialists on their medical staffs to accept an allocation of uninsured office-based referrals.
为专科服务安排转诊通常是安全网接入项目在试图为未参保者提供相当全面的服务时面临的最大困难。当要求社区专科门诊医生照顾未参保患者时，他们提出了以下障碍：难以确定哪些患者值得慈善护理、必须为患者安排从其他医疗机构获取所需服务，以及担心提供护理不足而承担责任。解决这些专科接入障碍的办法可以在为未参保者提供初级保健和医院服务的相同机构安排中找到。这些安全网组织结构可以扩展到包括专科医生护理，方法是资助社区卫生中心为专科转诊签订合同，利用独立转诊项目补贴以折扣价接收未参保患者的社区专科医生，并通过免税或比例失调份额资金鼓励医院要求其医务人员中的专科医生接受一定数量的未参保门诊转诊患者。
