The costs and adequacy of safety net access for the uninsured in Genesee County, Michigan.

This commentary examines Genesee County (Flint) Michigan to explore whether a well-structured safety net system is able to provide low-income uninsured people adequate access to care at a reasonable cost. Genessee County is one of the more economically challenged communities in the country. This commentary explores the cost and adequacy of safety net care in Genessee County under the Genessee Health Plan (GHP). The analysis compares the cost of services under GHP to the cost of the same services offered by local private insurers and Medicaid. An analysis found that GHP, Flint-area physicians, hospitals, and foundations have succeeded in providing basic medical care access to a substantial majority of their low-income uninsured citizens. The costs of care, both paid by GHP and donated by local providers, are substantially less than the estimated costs if this population were covered by full Medicaid or private insurance.

Facilitating the development of a county health coverage plan with data from a community-based health survey.

Community-Based Participatory Research (CBPR) has the twin goals of generating data and shaping policy decisions, yet examples that combine these goals are scarce in the literature. We describe how a community-based survey was created and used to help develop a county health plan. The Genesee Health Plan (GHP), a community-initiated non-profit organization, provides primary care, prescription drugs, and specialty care to uninsured, low-income adults through a network of independent physicians, clinics, and hospital systems. As part of an advocacy effort, GHP supporters used results from the Speak to Your Health! Community Survey to gain financial and political support for GHP. Our study, which used CBPR principles, was created by the community, local health department, and university partners. As a result, Genesee County became one of the first counties in the United States to make basic health care available to nearly all of its uninsured, low-income adults.