National Academies Press: OpenBook

Access to Health Care in America (1993)

Chapter: Front Matter

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Access to Health Care in America. Washington, DC: The National Academies Press. doi: 10.17226/2009.
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Access to Health Care in America

Committee on Monitoring Access to Personal Health Care Services

INSTITUTE OF MEDICINE

Michael Millman, Ph.D., Editor

NATIONAL ACADEMY PRESS
Washington, D.C.
1993

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Access to Health Care in America. Washington, DC: The National Academies Press. doi: 10.17226/2009.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W., Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education.

This project was supported by the Kellogg Endowment Fund, the Johnson & Johnson Foundation, the Baxter Foundation, the Robert Wood Johnson Foundation (Grant #18455), the Health Care Services Administration (Contract #75-05-0080), Department of Health and Human Services, and Institute of Medicine internal funds.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on Monitoring Access to Personal Health Care Services.

Access to health care in America / Committee on Monitoring Access to Personal Health Care Services, Institute of Medicine ; Michael Millman, editor.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-04742-0

1. Health services accessibility—United States—Evaluation. I. Millman, Michael L. II. Title.

[DNLM: 1. Health Services Accessibility—United States. W 76 1592a]

RA407.3.I58 1993

362.1'0973—dc20

DNLM/DLC 92-48299

for Library of Congress CIP

Copyright 1993 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logo-type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

First Printing, March 1993

Second Printing, February 1994

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Access to Health Care in America. Washington, DC: The National Academies Press. doi: 10.17226/2009.
×

COMMITTEE ON MONITORING ACCESS TO PERSONAL HEALTH CARE SERVICES

JACK HADLEY (Chair), Co-Director,

Georgetown University Center for Health Policy Studies, Washington, D.C.

LU ANN ADAY, Associate Professor of Behavioral Sciences,

University of Texas School of Public Health, Houston

JOHN BILLINGS, Health Policy Consultant,

New York, New York

CHARLES BRECHER, Professor,

New York University, and member, Citizens Budget Commission, Scarsdale, New York

TIMOTHY S. CAREY, Assistant Professor of Medicine,

University of North Carolina at Chapel Hill, North Carolina

ALAN B. COHEN, Vice President,

The Robert Wood Johnson Foundation, Princeton, New Jersey

EZRA C. DAVIDSON, Jr.,* Professor and Chairman,

King/Drew Medical Center, Los Angeles, California

CHESTER W. DOUGLASS, Professor and Chairman,

Department of Dental Care Administration, Harvard School of Dental Medicine, Boston, Massachusetts

ARNOLD M. EPSTEIN, Associate Professor of Medicine and Health Care Policy,

Harvard University School of Medicine, Boston, Massachusetts

JOHN G. LOEB, Deputy Executive Director,

Health Management Corporation, Philadelphia, Pennsylvania

JOANNE E. LUKOMNIK, Special Assistant to the Dean,

Albert Einstein College of Medicine, New York, New York

JANET B. MITCHELL, President,

Center for Health Economics, Waltham, Massachusetts

IRA MOSCOVICE, Professor and Associate Director,

Division of Health Services Research and Policy, University of Minnesota, Minneapolis

DONALD L. PATRICK, Professor,

School of Public Health and Community Medicine, University of Washington, Seattle

FERNANDO M. TREVINO, Dean and Professor,

School of Health Professions, Southwest Texas State University, San Marcos

GEORGE VAN AMBURG, State Registrar and Chief,

Center for Health Statistics, Lansing, Michigan

JOSEPH WESTERMEYER, Professor and Head,

Department of Psychiatry and Behavioral Sciences, University of Oklahoma, Oklahoma City

*  

Member, Institute of Medicine

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Access to Health Care in America. Washington, DC: The National Academies Press. doi: 10.17226/2009.
×

Study Staff

MICHAEL L. MILLMAN, Study Director

DEE SUTTON, Study Secretary

KARL D. YORDY, Director,

Division of Health Care Services

DON TILLER, Administrative Assistant,

Division of Health Care Services

HOLLY DAWKINS, Research Assistant,

Division of Health Care Services

SUSANAH GINSBERG, Consultant

GREG W. PEARSON, Consultant

ROBERT A. WALKINGTON, Consultant

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Access to Health Care in America. Washington, DC: The National Academies Press. doi: 10.17226/2009.
×

2

 

A MODEL FOR MONITORING ACCESS

 

31

   

Defining Access,

 

32

   

Measuring Access,

 

34

   

Indicators,

 

34

   

Utilization and Its Relationship to Health Care,

 

37

   

Barriers to Access,

 

39

   

References,

 

44

3

 

USING INDICATORS TO MONITOR NATIONAL OBJECTIVES FOR HEALTH CARE

 

46

   

Objective 1: Promoting Successful Birth Outcomes,

 

49

   

Utilization Indicator: Adequacy of Prenatal Care,

 

49

   

Outcome Indicator: Infant Mortality,

 

56

   

Outcome Indicator: Low Birthweight,

 

61

   

Outcome Indicator: Congenital Syphilis,

 

66

   

Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases,

 

69

   

Utilization Indicator: Preschool Immunization,

 

69

   

Outcome Indicator: Incidence of Vaccine-Preventable Childhood Diseases,

 

75

   

Objective 3: Early Detection and Diagnosis of Treatable Diseases,

 

79

   

Utilization Indicators: Breast and Cervical Cancer Screening Procedures,

 

79

   

Outcome Indicator: Incidence of Late-Stage Breast and Cervical Cancers,

 

86

   

Objective 4: Reducing the Effects of Chronic Diseases and Prolonging Life,

 

91

   

Utilization Indicator: Continuing Care for Chronic Diseases,

 

91

   

Utilization Indicator: Use of High-Cost Discretionary Care,

 

98

   

Outcome Indicator: Avoidable Hospitalization for Chronic Diseases,

 

102

   

Outcome Indicator: Access-Related Excess Mortality,

 

106

   

Objective 5: Reducing Morbidity and Pain Through Timely and Appropriate Treatment,

 

112

   

Utilization Indicator: Percentage of Healthy Individuals Who Do Not Contact a Physician During an Acute Episode of Illness,

 

112

   

Utilization Indicator: Dental Services,

 

115

   

Outcome Indicator: Avoidable Hospitalization for Acute Conditions,

 

121

   

References,

 

124

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ACCESS TO HEALTH CARE IN AMERICA

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Access to Health Care in America Get This Book
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Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators.

This useful volume defines a set of national objectives and identifies indicators—measures of utilization and outcome—that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location.

The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring.

This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.

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