Local advocacy for the medically indigent; strategies and accomplishments in one county

A major policy issue in the United States has become health care for the medically indigent. Persons without funds or insurance are not assured of receiving basic services or adequate health care. The burden of responsibility has come to rest on the local level and community-based coalitions have approached the problem with a variety of strategies. A summary of the history of advocacy efforts and a local background of how this problem has been addressed in Orange County, California are presented. Several approaches that were developed in conjunction with patients and private practitioners are outlined. Local advocacy efforts have provided modest improvements in opening health care services to the indigent. Increased funding for prenatal care and community clinics, expanding access and limiting restrictions on eligibility requirements have been some of the positive results. Many of the efforts by local advocates have been, out of necessity, defensive ones. This has hampered the development of programs with an emphasis on creative alternatives. Although there is evidence that community efforts are widespread, the lack of a well organized and broader based system restricts efforts to develop a national program that will provide universal entitlement to all individuals who reside in this country.