One in five Washington, D.C., residents does not have a regular source of health care, and increasing rates of hospital visits suggest that access to doctors and community clinics is declining in the district, according to a report presented to the D.C. Council on Wednesday, the Washington Post reports.

The study, which was conducted by RAND and commissioned by the council in 2006, found that less than 10% of district residents are uninsured. However, district residents with preventable or treatable conditions routinely seek care at hospitals. Nicole Lurie, a senior scientist at RAND, said the rates of people seeking care at hospitals are "startlingly high" and have gotten worse since 2004. According to the report, at least 40% of young children and adults on Medicaid visit a hospital emergency department at least once annually. The report found that the proportion is greater among adults with chronic conditions. Fewer than 20% of district residents with heart disease see a cardiologist annually, but more than 70% visit the ED at least once annually.

RAND in the report wrote, "There appears to be considerable room for improvement in quality of care." The report suggests incentives to encourage physicians to serve in communities with the greatest needs and to persuade patients to "use care appropriately." In addition, the report said there are large gaps in data needed to improve services and found that 80% of district residents have not visited a dentist in five years or longer (Levine, Washington Post, 1/31).

In related news, council member David Catania (I) this year will propose a universal care program intended to act as a "bridge" to health insurance to those who do not qualify for Medicaid but do not have access to employer-based care, the Washington Times reports. The program, known as Healthy D.C., would be partially subsidized by the government and would include an income-based premium (Emerling, Washington Times, 1/31).

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