An evaluation of San Mateo County's comprehensive health system redesign initiative finds notable improvements in access to high quality patient care for formerly uninsured adults. For example, the percent of such individuals having a usual source of care rose from 42.5 to 91.2 percent with the initiative. The initiative met with success despite mounting fiscal challenges associated with the economic recession and state budget crisis – threatening the county's ability to support these innovations. The county's efforts offer lessons for local and national policymakers, program administrators, and providers about how progress is possible despite severe financial obstacles.
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In early 2008, San Mateo County embarked on a comprehensive health system redesign initiative. This initiative is designed to improve access to high-quality care for uninsured and underinsured adults, while supporting the financial sustainability of the San Mateo Medical Center delivery system. The launch of this effort, however, coincided with mounting fiscal challenges associated with the economic recession and state budget crisis that threatened the county's ability to support these efforts. Despite these challenges, the county has made significant progress in improving access and patient care. The purpose of this brief is to present initial findings from a comprehensive evaluation conducted by the Urban Institute and the University of California San Francisco and to offer lessons for local and national policymakers, county leaders, program administrators, and providers about how progress is possible despite severe financial obstacles.
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