Using a voucher system to extend health services to migrant farmworkers

Family Health/La Clinica de los Campesinos, Inc., is a federally funded migrant health clinic in the heart of Wisconsin's farmland that has offered outpatient health care since 1973 and an accompanying "voucher" program since 1988. The charges for outpatient care are based on the ability to pay. The clinic issues vouchers not only to migrant workers living and working in remote parts of the State but also to patients needing services the clinic does not offer. Between 1 April 1992 and 30 March 1993, 677 participants submitted 1,794 vouchers that provided for $83,833 in partial health care payments. La Clinica paid a median amount of $22 for each voucher, its reimbursement value ranging from $1 to $979. Hospitals received the highest median payment and pharmacies the lowest. Voucher payments generally covered 60% of the bill, but dentists commanded a higher percentage (70%) and clinics and medical groups a lower one (42%). Most vouchers paid for procedures and services La Clinica could not provide. This program shows how a health care provider in one location, with a patient population scattered throughout a sizable geographic area, can coordinate services not offered at its facility. With the national spotlight on health care reform, the concept of vouchers for people in outlying or underserved regions deserves further investigation.