Access to Health Care in America (1993) / Chapter Skim
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2. A Model for Monitoring Access
2. A Model for Monitoring Access
Pages 31-45
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From page 31... ...
The care we might receive goes well beyond the physician's office to other settings and practitioners from therapists to visiting nurses, from hospital emergency departments to public health clinics. The one-on-one interaction of provider and patient in an array of settings is often called the personal health care system.
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From page 32... ...
Perhaps the most extensive effort to sort out the meanings of access and the related concept of equity was mounted by the 1983 President's Commission for the Study of Ethical Problems in Medicine and Biomedicine and Behavioral Science Research. The commission described society's ethical obligation to ensure access as follows: "Equitable access to health care requires that all citizens be able to secure an adequate level of care without excessive burdens" (President's Commission for the Study of Ethical Prob
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From page 33... ...
In applying its definition of access the committee sought to occupy a practical middle ground between all care that people might want or believe they needed and the view that medical care can make an important difference in people's lives. The definition forces us to identify those areas of medical care in which services influence health status and then to ask whether the relatively poorer outcomes of some population groups can be explained by problems related to access.
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From page 34... ...
MEASURING ACCESS Indicators To the extent that they reflect objective conditions and social values, indicators can mobilize sociopolitical pressures to raise the overall health levels of the population. They can also provide insight into how well medical knowledge is being applied in a given society to a given population.
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From page 35... ...
27~. Similarly, the access monitoring indicators recommended by the committee are intended to sense when and where access problems occur in the personal health care system.
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From page 36... ...
The literature on social indicators makes a distinction between descriptive and analytic indicators, the latter being grounded in theoretical models in which an interrelationship among variables is explicit. For example, the interrelated components of economic models are indicators whose variation tells us a great deal about the functioning of the economic system (Ross)
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From page 37... ...
An additional limitation of using utilization of health care services as a way to measure access is that it is frequently impossible to track all the services people need when they need them, especially for complex chronic diseases. Looking at health care outcomes is a complementary approach to measuring access.
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From page 38... ...
Even when the poor receive services from hospital outpatient departments or emergency rooms, or in public health clinics, the care may be fragmentary and lack continuity from one visit to the next. These examples may more properly fall under the heading of quality than access, but often the two concepts overlap.
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From page 39... ...
Structural Barriers The post-World War II solution to health care access problems was to expand the basic supply of hospital beds and later, in the 1960s, the supply of health care professionals. The federal government adopted a policy of capacity building at the local level partly in recognition of the fact that the recently enacted Medicare and Medicaid entitlements would strain the health care delivery system by increasing the demand for medical care.
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From page 40... ...
The implicit lesson from this brief historical overview is that most structural barriers to access have their roots in the way health care is financed. Despite a greatly enlarged physician force and the existence of some 600 community health centers, many of today's poor still find it difficult to identify physicians who will accept Medicaid.
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From page 41... ...
The ability to pay for medical care is closely linked to having public or private health care coverage. Financial barriers to health care access may manifest themselves in several ways: eligibility/insurability, benefit coverage, and reimbursement levels.
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From page 42... ...
Much of their care is financed through direct service delivery programs supported by federal, state, and local budgets or is delivered by institutional and individual providers in the form of free or reduced-price services. Included are the budgets of public hospitals, health department clinics, facilities run by the Department of Veterans Affairs, and community health center clinics.
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From page 43... ...
Migrant farm workers, refugees, newly arrived immigrants, the functionally illiterate, and the homeless who are likely to have worse-thanaverage health status may need translators, outreach workers, and sensitive practitioners to overcome cultural and other barriers to care that could make a difference in their health status. Much recent research on access problems in the Hispanic and black communities has sought to disentangle the role of cultural factors from other barriers.
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From page 44... ...
Social Indicators Research 1:5971. Employee Benefits Research Institute.
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From page 45... ...
1980. The Handbook of Social Indicators: Sources, Characteristics, and Analysis.
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