Assessing the Effectiveness of Policies to Improve Access to Primary Care for Underserved Populations: A Case Study Analysis of Columbia County, Arkansas

Focus Area:
Primary Care Transformation
Health Equity Rural Health

Funding for this project was provided by the National Institute for Health Care Reform. Read a related report reviewing the evidence on the effectiveness of these policies.


This case study of Columbia County, Arkansas, is the third in a series of case studies designed to assess the effectiveness of various policy initiatives to expand access to primary care in a region, particularly for underserved populations. Columbia County is a rural county with a higher proportion of Black residents than the rest of Arkansas. The median income of Columbia County is significantly lower than the rest of the state, and about a fifth of the county’s residents fall below the poverty line. The county is classified as a primary care health professional shortage area, and the underserved residents of the county experience several barriers to accessing primary care.

The entire state of Arkansas, including Columbia County, is experiencing a significant shortage of primary care physicians. A lack of medical schools and residency training opportunities in the region have made it especially difficult for health systems and provider groups in Columbia County to recruit and retain new doctors. The high demand for primary care physicians and the large compensation packages that big, more urban hospital systems can offer have made it difficult, if not impossible, for outpatient family medicine clinics in areas like Columbia County to compete. Recently enacted scope-of-practice expansions for nurse practitioners and other non-physician providers could help alleviate some of the provider shortages experienced by Columbia County and other rural areas in the state.

Columbia County currently has no federally qualified health centers (FQHCs) or school-based health centers, but it does have a rural health clinic that serves as a safety net provider for the community. Many residents of the county also lack access to transportation, and few providers offer after-hours appointments. While the COVID-19 pandemic has spurred an increase in the use of telehealth, the benefits have not been widely shared, as many residents do not have smartphones or high-speed broadband.

A few of the state’s health policy decisions have helped improve access to primary care for underserved populations. Expanding Medicaid has helped make primary care more affordable. The state has also encouraged a Medicaid patient-centered medical home program that has helped primary care practices deliver higher-quality care. However, these efforts have been insufficient in terms of improving access to primary care in Columbia County. The state’s investment in primary care, whether in terms of improving recruitment and retention of primary care clinicians or supporting the expansion of safety net clinics, has been limited and piecemeal. Counties like Columbia County lack the financial and systemic support necessary to strategize about improving population health in the long term.

Read the Columbia County case study



Kona M. Houston M. Clark J. Walsh-Alker E. Assessing the Effectiveness of Policies to Improve Access to Primary Care for Underserved Populations: A Case Study Analysis of Columbia County, Arkansas. The Milbank Memorial Fund. January 12, 2023.

 Case Study

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