RWJF

Repairing the Safety Net
People without health insurance often cannot afford regular health care and are forced to rely on the safety net—the patchwork of services offered primarily through clinics and emergency rooms—for their most acute health care needs. As a result, hospital emergency rooms are often overcrowded and unable to handle rising volumes of patients. An April 2002 national survey found that 62 percent of all U.S. hospital emergency departments were at or over operating capacity, with the proportion rising to 79 percent for urban hospitals and 87 percent for Level I trauma centers. In September 2002, RWJF unveiled a new initiative, Urgent Matters, to provide technical assistance to hospitals to help them reduce emergency room overcrowding. Grantees will also undertake a research-based assessment of their local safety net to serve as a springboard to raise awareness with local stakeholders about emergency room capacity and use. The program will also fund four demonstration sites to implement innovative models to improve the flow of patients through emergency departments.

Addressing Racial and Ethnic Disparities in Health Care
Although certain barriers to accessing health care exist across all racial and ethnic groups, some disparities in health care can be attributed to race or ethnicity alone. In 2002, following on the heels of a groundbreaking report issued by the Institute of Medicine on racial and ethnic disparities in health care, a report by the Henry J. Kaiser Family Foundation and the American College of Cardiology Foundation examined 81 cardiac care studies and identified disparities in care for at least one racial/ethnic minority group in at least two-thirds of the studies. This report is the central feature of the Initiative to Engage Physicians in Dialogue about Racial/Ethnic Disparities in Medical Care, co-sponsored by RWJF and the Kaiser Family Foundation. The partnership with organizations such as the American College of Cardiology Foundation and the Association of Black Cardiologists has committed $1 million to raise awareness among physicians of these disparities.

The project has two main components: an advertising campaign in major medical publications and an outreach effort to engage physicians in discussion of how to reduce racial and ethnic disparities. The program, launched in late 2002 with advertisements in 10 leading medical publications, encourages physicians to review a Web-based research report on racial/ethnic differences in cardiac care and evidence-based guidelines for quality care.

Strengthening the Oral Health Delivery System
In 2000, the first-ever Surgeon General’s report on oral health identified a “silent epidemic” of dental and oral diseases among certain populations, particularly those who are poor, medically disabled or geographically isolated. Research has shown that poor oral health is a key indicator of poor health overall. Experts suggest that the decline of oral health in these populations could be addressed in part through increasing the numbers of underrepresented minorities in dentistry and other health care professions.

In 2002, the Foundation awarded $15 million in five-year grants to 10 dental schools through the Pipeline, Profession and Practice: Community-Based Dental Education program. The goals of the program are to change the curricula of these schools to teach students about community-based dental practices, encourage schools to expand their clinical training of students in underserved areas and increase the number of underrepresented minority and low-income students training to become dentists.

In Washington state, where 25 percent of families cannot access dental care, the University of Washington dental school expects to triple the number of fourth-year dental students it places in the state’s rural and urban community clinics. In North Carolina, a state with a dental workforce shortage, the University of North Carolina dental school will increase dental enrollment and expand its community-based clinical education. Other schools will offer language classes to dental students to enable them to better communicate with non-English-speaking patients.

States can also play a significant role in increasing the availability of oral health services. In 2002, the $6-million State Action for Oral Health Access program awarded grants to six states that had proven track records in improving public coverage programs like Medicaid and SCHIP. The grants will enable these states to test innovative approaches to improving access to oral health services for low-income, minority and disabled populations served by Medicaid, SCHIP and the public health system. Arizona, for example, is designing and purchasing mobile dental units to provide oral health access in rural parts of the state. Pennsylvania plans to expand the provider network and dental safety net for low-income people with special needs. Vermont expects to expand oral health care education to consumers and providers, establish a primary care dental home for youths incarcerated in juvenile justice programs, link registered dental hygienist assessments of school children with community dentists, and collaborate with education agencies to recruit and retain dentists.

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