Center for Studying Health System Change

lthough few respondents identified indigent care as a major health care issue facing the community, Little Rock has a large number of uninsured residents and what appears to be inadequate access to physicians and other outpatient ser-vices for the community’s poor, uninsured population. University Hospital is the principal source of inpatient charity care; several other hospitals provide more limited care to indigent patients. University Hospital’s ability to continue serving in this role is uncertain, however, particularly if state or federal action results in cuts in Medicaid payments, the hospital’s principal source of subsidies for uninsured patients. Moreover, UAMS sources noted that University Hospital’s reputation as the principal provider of care to the poor has complicated the hospital’s efforts to draw more private pay patients to its emergency room and outpatient clinics.

The hospital emergency room serves as the principal point of access for many indigent patients, and the site visit team identified few other significant sources of outpatient care for uninsured persons. The only federally qualified health center in the area is a clinic located near the airport, which provides about 5,000 visits a year. Only about one-third of the center’s services are provided to uninsured patients, however, and the facility was totally destroyed by a tornado in early 1997. St. Vincent’s sponsors a free clinic for poor patients once a week, and the medical society organizes a program to encourage private practice doctors to see indigent patients in their offices, although this program is characterized as quite limited.

A sizable share of the indigent care burden appears to be shouldered by the state Department of Health and, to a lesser extent, by the Veterans Administration system. Although the health department is not organized or sufficiently funded to play a major role in the provision of acute care services, public health nurses and other staff frequently provide limited primary care during visits for preventive services such as immunizations. Consequently, as the de facto provider of last resort, the Health Department has been forced to divert resources from other activities such as the conduct of more regular health assessments and disease surveillance. The VA medical complex in Little Rock may also be serving a large share of indigent patients. Thirty percent of eligible veterans in the area use the system compared with a national average of about 10 percent, and the VA’s ambulatory care clinics also generate 288,000 outpatient visits a year, one of the highest numbers of any VA facility in the country.²³