CHCF Releases Two Briefs on Health Care Access Issues

Medi-Cal beneficiaries’ access to physicians and uninsured access to specialty care examined


The California HealthCare Foundation (CHCF) today released two issue briefs examining access to physician services by some of the state’s most vulnerable populations: Medi-Cal and Healthy Families beneficiaries, and people who have no health insurance.

The first issue brief, Access to Physicians in California’s Public Insurance Programs, provides insight into the issues associated with access for those covered by California’s Medi-Cal and Healthy Families programs. The authors summarize the findings from five studies commissioned by CHCF and the results of an extensive review of literature. The findings underscore areas for improvements in California’s public insurance programs and suggest dimensions of access that should continue to be monitored. Key findings include:

  • Enrollment in Med-Cal and Healthy Families improves access to physician services; however, access is worse for those whose coverage is intermittent;
  • Adult beneficiaries experience more access problems than children enrolled in these public programs;
  • Beneficiaries with chronic illnesses and those who require specialty care face more access problems;
  • Medi-Cal beneficiaries enrolled in fee-for-service Medi-Cal may experience worse access than those enrolled in Medi-Cal managed care; and
  • There are large differences in access across counties for those covered by Medi-Cal and Healthy Families.According to Chris Perrone, senior program officer, CHCF, “As California policymakers debate options for addressing the state’s budget problems, it is vitally important that they understand both the successes of Medi-Cal and Healthy Families and the challenges still facing these programs, which will account for nearly one-in-six General Fund dollars spent this year.” Perrone adds, “Together these programs greatly improve access to care for 7.5 million Californians, yet low Medi-Cal payment rates and other factors contribute to access problems for many beneficiaries, particularly for some types of specialty care.”

    The second brief, Examining Access to Specialty Care for California’s Uninsured, answers the questions: How, and with what ease, are California’s uninsured able to obtain specialty care, and how do communities vary in terms of access to specialty care? The research team found widespread problems in access to specialty care for the uninsured, with many communities experiencing worse access compared to just a few years ago.

    The authors conducted interviews with medical directors of federally qualified health centers (FQHCs) in California and surveyed 64 hospitals named by the FQHC medical directors as places where they commonly refer uninsured patients for specialty care. Case studies of the safety net for specialty care were also conducted in four communities.

    Findings from the surveys include:

  • Eighty-five percent of the FQHC medical directors reported that their patients “often” or “almost always” have problems in obtaining specialty care;
  • FQHC medical directors characterized adults’ access as “often” or “almost always” problematic for 16 of the 24 specialties surveyed. Neurology, allergy/immunology, and orthopedics were among the specialties most frequently cited as problematic; and
  • Waiting times for the most problematic specialties are often months long, as shown by the case studies and the hospital outpatient department survey.According to Marian Mulkey, senior program officer at CHCF, “Uninsured individuals rely on the safety net—community clinics, hospitals, and private physicians who deliver care without respect for ability to pay—to provide them with basic and preventive health care. But fragile clinic funding arrangements, worries among private physicians about incurring significant financial risks, and the short supply of specialists mean that many uninsured Californians with complex or chronic conditions go without the specialty care that could play a key role in stabilizing or improving their health.”

    Examining Access to Specialty Care for California’s Uninsured also lists short-term action steps for local health leaders to assess and address specialty care for the uninsured, and longer-term implications for state and national policymakers.

    Mathematica Policy Research, Inc. prepared both reports for CHCF. The reports are available online through the links below.


Contact Information:
Sally Mudd
Director of Engagement


About the California Health Care Foundation

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.