Virginia's Fairfax County is one of the wealthiest communities in the nation, yet in 1985, 78,000 Fairfax residents—10 percent of the County's population—were not covered by medical insurance. Among the uninsured were 19,000 children under the age of 18. Private physicians and hospital emergency rooms were being inundated with requests for treatment of the children of the working poor, whose families earn between $5,800 and $15,125 per year and did not qualify for Medicaid. A few health care providers who saw the youth coming in with temperatures of 105, open-running sores, hacking coughs, severe weight losses, anemia, and heart ailments treated them as charity cases, but this was only a temporary fix. Without comprehensive health coverage, thousands of indigent children were falling through the cracks every year.
In July 1986, the County's Department of Community Action launched the Medical Care for Children Project (MCCP), a pioneering public-private partnership to provide low-cost medical and dental services to uninsured children. The County recruited two major health-maintenance organizations (HMOs)--Kaiser Permanente and the Group Health Association--to form the basis of this venture. MCCP is revolutionary in its comprehensive approach to low-income health care. Rather than just sending low-income families to a clinic, MCCP makes a concerted effort to preserve the dignity of every client. The program's wide range of services is designed not only to alleviate each family's health concerns but also to lift them out of poverty so that they might be able to afford adequate health coverage on their own.
The structure of MCCP rests on the principle that if each party provides a proportionally small investment, everyone will be able to derive a maximum return. As of 1990, some 75 private physicians, 125 specialists, seven pharmacies, three laboratories, one urgent care center, two hospitals, 50 dentists, and three oral surgeons within Fairfax County had signed on with the project. Each agreed to provide medical services to uninsured children--from emergency care to routine checkups to immunizations--at rates that are zero to fifty percent of the actual cost of treatment. For a physical, a doctor can charge no more than $11 while the family pays only one dollar, with the County covering the rest. Since primary care is now an affordable option, unnecessary visits to the Emergency Room have declined significantly, and hospitals' financial losses have been reduced. Doctors are now compensated for cases that they may have treated earlier as charity, and low-income children are guaranteed the health care that they deserve.
Outreach workers go door-to-door in poor neighborhoods to explain and promote the new services. Community social workers help identify and enroll the children, and then arrange medical appointments, transportation, and translation services for the County's many immigrant families. The social workers also offer to help the children's parents find jobs, housing, and counseling, with the goal of enabling each client to be self-sufficient in two to three years.
By 1990, MCCP had treated over 2,256 children who otherwise would not have received care. The entire Fairfax community strongly supports the program, as it is a cost-effective solution that combines the existing resources of the County government, the medical community, and area businesses. The County estimated that its $175,000 investment in the partnership had provided more than $500,000 worth of medical services for the youth. In 1990, Fairfax County's business community pledged to raise $150,000 for the program's expenses. By effectively convincing businesses and private physicians that they too have a corporate and social responsibility to help provide health care for impoverished children, MCCP has developed a comprehensive and easily replicable plan to serve the health and social needs of numerous indigent families.