The Regional Health Commission produces an annual “Access to Care” data book, which reviews community-wide progress toward strengthening the health care safety net system in the region. Data is gathered from safety net provider institutions across St. Louis City and County. We can use this information to:

  • Assess the current capacity of the region’s health care safety net
  • Leverage data to advocate for improved health care policy
  • Elevate the lived experience of uninsured and underinsured patients across the health care system
  • Address social determinants of health
  • Work as a region to improve health outcomes and increase access to care

Executive Summary

  1. The overall rate of uninsured individuals has continued to steadily decline in St. Louis City and County over the past four years, with more people being covered through both commercial and public insurance.
  2. There continues to be a shift in the payor mix of St. Louis safety net organizations.
  3. Wait times across primary and specialty care safety net sites continue to lengthen over time.

Key Findings

Primary care encounters include adult medical, pediatric, obstetrical, behavioral, dental, and “other” medical-related encounters that occur at a participating primary care organization.

Primary Care Encounters by Payor Category

Over the last four years, uninsured and Medicaid encounters made up between 74% and 76% of the total encounters at safety net primary care organizations.

Graph of insurance payor categories for Primary Care Encounters from years 2015 to 2018

Primary Care Uninsured Users Served by
Total St. Louis Uninsured Population

Who are we serving? Safety net primary care providers served roughly 78% of the total uninsured population in St. Louis City and County in 2018.

Primary care uninsured users served by total St. Louis uninsured population from 2015 to 2018

Emergency care encounters are encounters that occur at hospital emergency departments.

Emergency Department Encounters by Payor Category

Over the last four years, the payor mix at safety net emergency departments has remained relatively stable among the four categories.

emergency department encounters by payor category from 2015 to 2018

Familiar Faces at Emergency Departments

In 2018, 18,808 patients visiting St. Louis area emergency departments had 4 or more emergency department visits at the same hospital.

familiar faces at emergency departments by payor category in 2018

Familiar Face Users by Payor Category, 2018

“Many adults that want to utilize healthcare services work their full-time or part-time jobs during the hours that most FQHC’s [Federally Qualified Health Centers] are open. This contributes to these individuals seeking out urgent care services (some that don’t necessarily take Gateway payment) or going to a 24-hour Emergency Department because they know they will be seen.”

Support Staff at Safety Net Provider Organization

Familiar Faces Encounters Among Uninsured Patients at Emergency Departments

Where are uninsured familiar faces receiving emergency care?

graph of where familiar faces are receiving emergency care

Patients identified as familiar faces had 103,300 emergency department encounters at St. Louis area hospitals in 2018. Of these encounters, over 13,300 were among uninsured patients.

Specialty care encounters are specialized medical services provided by a physician specialist in a non-primary and non-emergency department setting.

Specialty Care Encounters by Payor Category

Over the last four years, privately insured encounters made up more than half of all specialty care encounters. In the same time frame, uninsured encounters* made up less than 5% of all specialty care encounters.

specialty care encounters by payor category from 2015 to 2018

Wait Times for New Patients at Frequently Utilized Specialty Departments, 2018

wait times for new patients at frequently utilized specialty care departments in 2018

Departments highlighted in red have the highest referral rates among GBH patients.

“Appointments for many specialties are booked several months out. When an urgent appointment is requested patients don’t hear from anyone and have to call the streamline dept. where they are told the notes are in review. The referral dept. is great but the clinics are very difficult.”

Support Staff at Safety Net Provider Organization

Behavioral health encounters are ones that occur at primary care organizations and emergency departments that are coded as a mental health or substance abuse diagnosis.

Behavioral Health Encounters by Type of Care

Since 2015, emergency care behavioral health encounters have remained relatively stable, while primary care behavioral health encounters have increased by 34%.

behavioral health encounters by type of care from 2015 to 2018

Total Inpatient Psychiatric Encounters, 2017-2018

total inpatient psychiatric encounters from 2017 to 2018

Staffed Inpatient Behavioral Health Beds, 2017-2018

staffed inpatient behavioral health beds from 2017 to 2018

While overall psychiatric encounters have stayed consistent over the last year, the number of staffed inpatient beds has decreased.

Additional Information

For the purposes of the “Access to Care” data book, individuals enrolled in Gateway to Better Health were categorized into the “Uninsured” payor category. Gateway to Better Health (GBH) is a temporary health care program designed to provide uninsured adults a bridge in care until they are able to enroll in healthcare options provided by the Affordable Care Act. Learn more about Gateway to Better Health.

Related Data

This issue brief acts as a supplement to data provided in the 2017 Access to Care report and focuses on geographic access trends among uninsured patients. Utilizing patients’ zip code of residence, this issue brief tracks the number of uninsured patients living in St. Louis City and County who were served by local safety net providers.

This review provides a comprehensive summary of leading health indicators and disparity metrics in St. Louis City and County from 2000-2010.

St. Louis Partnership for a Healthy Community Logo

Think Health St. Louis is a web-based source of population data and community health information. The RHC was a Founding Partner of the St. Louis Partnership for a Healthy Community that developed the Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP).

United States Census Bureau Logo is the new platform to access data and digital content from the U.S. Census Bureau. The RHC utilizes Census Data in conjunction with the Access to Care information collected for these reports.


To learn more about the Access to Care Data Book, please contact Blessing Kuebee.