• Wayne County has a higher death rate than Michigan.
• The cities of Detroit, Ecorse, Highland Park, Taylor, and the City of Wayne have substantially higher than average health disease death rates and generally higher than state average cancer and diabetes mellitus rates indicating need for great access to comprehensive quality primary care services.
• The infant mortality rate for Detroit is more than three times the rate for the top five states.
• The Detroit metropolitan area lacks the resources to respond to the health care needs of the underinsured. Wayne County receives $11.10 per low income resident compared with Ramsey County (St. Paul, Minnesota) which receives $46.41 and Marion County (Indianapolis, Indiana) $37.32.
• Emergency department use for primary and chronic care needs continues to be a problem. According to "Taking Care of the Uninsured: A Path to Reform," a book published locally, an average emergency department visit costs $412, while the cost of a primary care visit is $78.30. If ambulatory conditions were treated in a primary care setting rather than and emergency department, the savings would be about $333.
• Safety net performance can be improved: Uninsured ED access is high compared to the insured population. ED visits for Ambulatory Sensitive Conditions are 34 percent higher for uninsured than for all Wayne County residents. Hospital use by the uninsured in Detroit is lower than national rates. Even with the low rate, 34 percent of uninsured hospitalizations are for Ambulatory Sensitive Conditions.Eliminating Ambulatory Sensitive ED visits and hospitalizations could save nearly $5 million. Healthy lives indicators are below top performing states and should be targeted for improvement.

• Establish the Primary Care Network Council as a forum for encouragement and support of expanded Federally Qualified Health Center (FQHCs) services, specifically encouraging the cooperation of existing FQHCs.
• Identify and prioritize geographic areas on the basis of need for new or expanded health care services.
• Adopt a multi-faceted strategy for primary health care safety net expansion.
• Encourage any organization seeking to expand access to quality health care as long as the propose expansion will not result in a diminution of services to the underserved. 

Backgrounder
Commonwealth Fund studies suggest solutions to coverage for uninsured
 
In January, the Commonwealth Fund released three reports that cover various aspects of possible ways of covering the uninsured: 

• "Congressional Proposals Could Provide Coverage to All Americans;" This analysis  of leading health insurance bills of the 110th Congress indicates that several proposals would substantially reduce the number of uninsured Americans and either reduce health care spending or only add modestly to the cost of care
• "Citizenship Documentation Rules: A Barrier to Children's Coverage;" recent citizen documentation rules will adversely impact coverage for low-income children covered by state public programs, according to a Commonwealth Fund report. It finds that getting and keeping coverage has become more difficult.
• "A Down Payment on Health Reform;" This essay, written by Sherry Glieg, Ph.D., calls for using the upcoming reauthorization of the State Children's Health Insurance Program (SCHIP) as a means to achieve universal coverage for U.S. children - a change that could serve as a foundation for reforms later on.

For details of these studies, go to the Commonwealth Fund's site, www.commonwealthfund.org.