By Michelle Lau
Illustration by Malcolm Garris/PhotoDisc
February 15, 1999

Creating access to health care in California is a daunting goal. Twenty-three percent of state residents lack health insurance—the highest rate in the country. For Asian and Hispanic immigrants, the situation is even more bleak.

Nearly 3.9 million Asian and Hispanic immigrants in California are without health insurance, according to a 1997 study conducted by the UCLA School of Public Health. Many American Indians in the state are facing the same problems of access. "California Indians have been shortchanged adequate funding for health care since the late 1950s," said Carole Minear, a spokesperson for the California Rural Indian Health Board Inc. (CRIHB).

With such somber statistics, it’s easy to see why the W.K. Kellogg Foundation has chosen Asian Health Services (AHS) in Oakland, La Clínica de la Raza in Oakland, and the CRIHB to participate in a national initiative to improve healthcare access and quality. The five-year, $55 million project, which began in August, is called Community Voices: Health Care for the Underserved. Sacramento-based CRIHB, which is made up of 29 California Indian tribes and 11 tribal health programs, was awarded $2 million. Together AHS and La Clínica—which both serve Alameda County—were given an additional $2.5 million.

Developing solutions

"The foundation’s goal is not to come in with a model, but to view Community Voices as an experimentation process to give people on the community level the opportunity to develop community-based solutions," said Paul DelPonte, a consultant on the Community Voices project. These solutions, DelPonte said, will vary from site to site. For example, within the five years, some locations will find ways to offer extended levels of nursing care in schools, while others will experiment with healthcare payment options. The foundation will provide the participating communities a team of consultants to help with communications, public policy, and evaluation, he said. Each site is responsible for seeking matching funds.

"With the understanding that there really isn’t going to be any significant action on the national level in terms of universal health access any time soon, the goal—starting from the local level—is to develop a road map to how we can improve the healthcare system," DelPonte said.

Though Community Voices is still in its infancy, CRIHB has begun to target specific policy issues, including the feasibility of creating an Indian-controlled managed care system that reflects the needs of American Indian patients and clinics.

"The healthcare environment is changing. The ability of the community and Indian health clinics to survive in the new environment will depend upon their ability to adapt to the emerging managed care system," said Minear, who explained that California has the largest American Indian population in the country, with 104 federally recognized tribes. If a managed care system is found to be feasible, CRIHB executives think the organization could be in a better position to control standards of care while maintaining an Indian identity.

Insuring the underserved

AHS and La Clínica are also beginning to address policy issues with the help of Community Voices. For example, both organizations are working to find ways to expand eligibility for all children and adults who want to apply for the Healthy Families program in California. "We’re not naive enough to believe that we can reverse the system, but we’re going to try to manipulate it to allow for certain access to occur," said Jeanette Dong, the AHS and La Clínica Community Voices’ project director.

Working with Alameda Alliance for Health, a local insurance plan, AHS and La Clínica are also looking for ways to develop a health insurance product specifically for the uninsured and the working poor in the Asian and Hispanic populations, Dong said.

"There’s not a lot known about this population and their utilization of the healthcare system," said Dong, who said that both organizations have agreed to conduct market research on health care and Asians and Hispanics. The overall goal, Dong said, is to develop various solutions to providing health care so that government is not the only way to gain health access.

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