Casey, M., L. A. Blewett, and K. T. Call. 2004. “Providing Health Care to Latino Immigrants: Community-Based Efforts in the Rural Midwest.” American Journal of Public Health 94(10): 1709-1711.

We examined case studies of 3 rural Midwestern communities to assess local health care systems' response to rapidly growing Latino populations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and religious organizations connect Latinos to the health care system. However, many unmet health care needs result from lack of health insurance, limited income, and linguistic and cultural barriers. Targeted safety net funding would help meet Latino health care needs in rural communities with limited resources.

Blewett, L. A., M. Casey, and K. T. Call. 2005. “Improving Access to Primary Care for a Growing Latino Population: The Role of Safety Net Providers in the Rural Midwest.” Journal of Rural Health Special Issue 20 (3): 237-245.

CONTEXT: Many rural Midwestern communities are experiencing rapid growth in Latino populations with low rates of health insurance coverage, limited financial resources, language and cultural differences, and special health care needs. PURPOSE: We report on 2-day site visits conducted in 2001 and 2002 in 3 communities (Marshalltown, Iowa; Great Bend, Kansas; and Norfolk, Nebraska) to document successful strategies to meet Latino health care needs. METHODS: We interviewed key informants to identify successful community strategies for dealing with health care access challenges facing the growing Latino population in the Midwest. FINDINGS: Interventions have been developed to meet new demands including (1) use of free clinics, (2) school health programs, (3) outreach by public health, social services and religious organizations, and (4) health care providers' efforts to communicate with patients in Spanish. Strain on safety net services for Latinos is due in part to a complicated and unstable mix of public and private funds, a large but overtaxed volunteer provider base, the dependence on a limited number of community leaders, and limited time for coordination and documentation of activities. CONCLUSIONS: We suggest the development of a Rural Safety Net Support System to provide targeted funding to rural areas with growing immigrant populations. Federal community health center support could be redirected to new and existing safety net providers to support the development of a safety net monitoring system.

Blewett, L. A., and T. J. Beebe. 2004. “State Efforts to Measure the Health Care Safety Net.” Public Health Reports 119 (2): 125-135.

This article describes the role states could play in a national effort to measure and monitor the public health safety net. The authors developed a data collection framework using information from five states on two components of the safety net: structure and demand. Because states are the primary vehicle for access expansions and programs to care for the poor, the authors suggest that they be the primary coordinating mechanism for data collection on the safety net. Because the necessary mechanisms for more uniform standards or criteria to evaluate state data collection activities and capacity remain undeveloped, they recommend using existing data to begin building state capacity to measure and monitor the safety net.

Blewett, L. A., M. Davern, and H. Rodin. 2005. “Employment and Health Insurance Coverage for Rural Latino Populations.” Journal of Community Health 30 (1):181-195.

Rural Latino populations continue to grow in part due to relocation of food processing industries to rural America along with other manufacturing and large retail stores. We use data from the Current Population Survey to examine the labor force participation of rural Latino population and the role rural employers play in providing health insurance coverage. We found that while rural Latinos are more likely to be uninsured, the meat packing industry has higher health insurance coverage rates than other rural employers such as construction and retail. Local communities recruiting new businesses to their rural communities need to explore the role that employers will play in providing health insurance coverage. Lack of adequate coverage will have an impact on the income, resources, and day-to-day activities of physicians, hospitals and traditional safety net providers.

Blewett, L. A., J. Ziegenfuss and M. Davern. 2008. “Access to ‘Local Access to Care Programs’: New Developments in the Access to Care for the Uninsured.” Milbank Quarterly 86(3): 459-479.

CONTEXT: New, locally based health care access programs are emerging in response to the growing number of uninsured, providing an alternative to health insurance and traditional safety net providers. Although these programs have been largely overlooked in health services research and health policy, they are becoming an important local supplement to the historically overburdened safety net. METHODS: This article is based on a literature review, Internet search, and key actor interviews to document programs in the United States, using a typology to classify the programs and document key characteristics. FINDINGS: Local access to care programs (LACPs) fall outside traditional private and publicly subsidized insurance programs. They have a formal enrollment process, eligibility determination, and enrollment fees that give enrollees access to a network of providers that have agreed to offer free or reduced-price health care services. The forty-seven LACPs documented in this article were categorized into four general models: three-share programs, national-provider networks, county-based indigent care, and local provider-based programs. CONCLUSIONS: New, locally based health access programs are being developed to meet the health care needs of the growing number of uninsured adults. These programs offer an alternative to traditional health insurance and build on the tradition of county-based care for the indigent. It is important that these locally based, alternative paths to health care services be documented and monitored, as the number of uninsured adults is continuing to grow and these programs are becoming a larger component of the U.S. health care safety net.

The appendix for this article is attached.