Michigan's state and local officials have created a joint city-county health care agency. The Detroit Wayne County Health Authority's goal is to link uninsured and Medicaid patients with primary care providers so that patients receive more regular treatment.

The Detroit agency, funded by a $500,000 federal appropriation and pledges of $1.5 million from foundations and other sources, is a reaction to the heavy use of emergency rooms for primary care or delayed treatments--a pressure that led the Detroit Medical Center to announce it might have to close two of its hospitals, which were leading providers of care for trauma victims and pregnant women in Wayne County. "DMC sounded an alarm, but all of the hospitals were struggling because of the challenges of providing care to the uninsured and underinsured," says Teresa Blossom, spokeswoman for Wayne County Executive Robert Ficano. The situation, Blossom says, "caused us to look at what we could do to address locally the challenges of a health care safety net in the absence of any federal action on the horizon."

Detroit has only three federally qualified health centers, while Cleveland, by comparison, has 30. As a result, 59 percent of Wayne County residents live in areas that are not served at all by primary care providers, as opposed to 9 percent in neighboring Macomb County and none in Oakland County. The hope is that the new health authority will reverse "the huge flight of providers," Blossom says, while encouraging residents to seek needed care from those that remain in Wayne County.

Other cities, such as Chicago and St. Louis, also have regional health authorities.