Specialty Care Demand by the Uninsured
Posted in Projects / Wed, March 13, 2013
Timeframe: 2008-2009 | Amount: $32,359.50
What’s the demand (need) for specialty care services by uninsured, low income persons?
The Pacific Hospital PDA had been funding specialty care for low-income, uninsured persons through grants to Pacific Medical Centers, starting in 2003, and to Project Access Northwest, starting in 2006. By 2008, it was clear that there was a scarcity of hard data about the actual demand for specialty care by this population. We looked at the number of low-income uninsured persons, the typical demand for specialty referrals and the supply of specialty care being provided by Project Access NW volunteer specialist providers, Pacific Medical Centers, Harborview Medical Centers, other health care groups and individual physicians.
The Pacific Hospital PDA first engaged an actuarial firm in 2008 to estimate demand for this population by looking at the firm’s databases for commercial populations, Medicare populations and Medicaid managed care populations. The Pacific Hospital PDA refined the question in 2009 to ask “how many specialist referrals are expected each year, by type of specialist, for working age adults (18-64) in King County who are uninsured and earn below 200 percent of the federal poverty level?” A special analysis of the state’s Uniform Medical Plan (UMP) data was determined to be the best source of information available for answering the question. Our consultant worked with the State of Washington to acquire this information.
- The best estimate available is that there are typically 0.52 referrals per person annually for specialty care.
- This translates into a demand for 51,700 specialty referrals annually per 100,000 persons for the King County adult, uninsured population.
- There is a high demand for certain specialties. The top 15 specialties account for 90 percent of all expected referrals. The top five specialties account for 55 percent of all likely referrals.
Building on the data compiled by our consultant, Pacific Hospital PDA staff reviewed information on expected demand by geographic area, as well as the number of specialists working in those areas. What we found was that there are not enough specialists in areas where we need them.
- We project a greater need for specialty care services in South King County and Seattle than other parts of King County.
- Despite a higher level of anticipated demand in South King County, there are fewer specialty providers in South King County than there are in Seattle and East King County.