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Strategies and Accomplishments in One County

Vicki Mayster, MA; Howard Waitzkin, MD, PhD; F. Allan Hubbell, MD, MSPH; Lloyd Rucker, MD

JAMA. 1990;263(2):262-268.

Abstract
Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved shortterm investigations of barriers to needed services so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence state and national policies that affect local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system that guarantees access, they can substantially improve the availability of local services.

(JAMA. 1990;263:262-268)

Author Affiliations
From the Orange County Task Force on Indigent Health Care and the Division of General Internal Medicine and Primary Care, University of California, Irvine.

Footnotes
Reprint requests to University of California, Irvine/ North Orange County Community Clinic, 300 W RomneyaDr, Anaheim, CA92801 (Dr Waitzkin).

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