Dr. Nathan Hale, research assistant professor and deputy director of the SC Rural Health Research Center at University of South Carolina’s Arnold School of Public Health, and colleagues Dr. Michael Smith (epidemiologist at the SC Department of Health and Environmental Control), Dr. James Hardin (associate professor and director of biostatistics at the Arnold School) and Dr. Amy Brock-Martin (adjunct faculty member at the Arnold School) found that the impact of shifting clinical services from health departments to primary care providers varied greatly among South Carolina communities.
With support from the Robert Wood Johnson Foundation, Dr. Hale and colleagues examined children’s use of Early Periodic Screening, Diagnosis and Treatment (EPSDT) services in South Carolina over a 15-year period. During this time, local health departments transitioned from providing these services directly to leveraging community provider resources.
The researchers found the impact of this transition varied greatly between urban and rural communities. In communities with adequate community-based primary care capacity, shifting clinical services from health departments to community providers had a marginal impact. Children’s access to these services improved over the long run in these communities. However, in rural and underserved communities, children’s access to care deteriorated, reflecting a greater reliance on health departments as direct providers of clinical services.
These findings, published in the American Journal of Public Health, are relevant to larger discussions about the organization and delivery of public health services but also highlight the persistent vulnerabilities in access to important health services in some communities, even when insured.