Commonwealth Fund survey says New Orleans safety-net clinics are succeeding

A Commonwealth Fund survey of safety-net clinic patients in New Orleans finds that only 27 percent went without needed healthcare because of cost, compared to 41 percent of adults across the country.

The report, “Coming Out of Crisis: Patient Experiences In Primary Care In New Orleans, Four Years Post Katrina,” finds that despite being disproportionately low-income and uninsured, these patients had fewer problems affording care and fewer instances of medical debt and inefficient care than most U.S. adults.

The study's authors say the post-Katrina primary care pilot program – a system that relies primarily on a large network of local clinics funded by federal and local government and given financial incentives to improve care – could serve as a national model for providing primary care to vulnerable groups.

“The healthcare safety net in New Orleans was devastated by Hurricane Katrina, but that also presented an opportunity to build something new from the ground up,” said Commonwealth Fund President Karen Davis. “It’s exciting to see the impact that a real focus on primary care can have on the health of this vulnerable population.”

Half of New Orleans' clinic patients have incomes below 200 percent of poverty, compared with one-third of all working-age adults in the United States.

“These findings reveal that strengthening primary care can be instrumental in helping to move the U.S. to a high performance health system,” said Commonwealth Fund Assistant Vice President Melinda Abrams, a co-author of the report.

According to Abrams, healthcare reform legislation currently before Congress includes medical home pilots to test different payment methodologies, increased payment for primary care in Medicare and loan forgiveness for physicians choosing careers in primary care.

Data for the study comes from the Commonwealth Fund 2009 Survey of Clinic Patients in New Orleans,  conducted Feb. 2-April 2, 2009, with a sample of 1,573 clinic patients aged 18 and older or adults accompanying a child under the age of 18.

Findings include:

• 88 percent of patients found it easy to get same- or next-day appointments, access medical advice via telephone or during regular practice hours or get after-hours care.
• 79 percent of patients reported exceptional communication with their doctors and 85 percent said their health needs are "very well" met by the clinics.
• 4 percent of clinic patients reported duplicate medical tests or that medical records or test results were unavailable at their appointment; overall, 34 percent of U.S. patients experience such problems.
• three-quarters said they would be "very confident" in their ability to get high-quality and safe medical care; in contrast, 39 percent of all U.S. adults are very confident that they could get high quality and safe care.