A Presentation by: Cynthia Brown, MBA, RHIT, CCS
Healthy People 2020 Objective:Emphasize the role of community partnerssuch as businesses, local governments, andcivic, professional, and religious organizationsas effective agents for improving health in theirlocal communities (Shi & Singh, 2010).
Healthy People 2020 “Health for All” Increase quality Promote healthy and years of behaviors healthy lifeEliminate health Promote healthy disparities communities Prevent/Reduce Diseases and Disorders
Access to Care DefinedThe ability to obtainneeded, affordable,convenient, acceptable ,and effective personalhealth services in a timelymanner (Shi & Singh,2008).
Key Implications of Access Key determinants of health, along with environment, lifestyle, and hereditary factors. Significant benchmark in assessing the effectiveness of the medical care delivery system (Healthy People 2020, performance/accountability of health care plans and providers. Determines whether or not delivery of health care is equitable. Linked to quality of care and efficient use of needed services (Shi & Singh, 2008).
Access to Health Services Topic Areas AHS-1 Increase the proportion of persons with health insurance (Medical, Dental, & Prescription Drug). Target: 100% Baseline: 83.2% AHS- 2 Increase the proportion of insured persons with coverage for clinical preventive services. AHS-3 Increase the proportion of persons with a usual primary care provider. Target: 83.9% Baseline: 76.3%
Access to Health Services Topic Areas AHS-4 Increase the number of practicing primary care providers (medical doctor, doctor of osteopathy, physician assistant, & nurse practitioner) AHS-5 Increase the proportion of persons who have a specific source of ongoing care. 5.1 All ages. Target: 95% Baseline: 86.4% 5.2 17 years and under Target: 100% Baseline: 94.3% 5.3 Adults 18 to 64 Target: 89.4% Baseline: 81.3% 5.4 Adults 65 and older Target: 100% Baseline: 96.3%
Access to Health Services Topic Areas AHS-6 Reduce the proportion of individuals who are unable to obtain or delay in obtaining necessary medical care, dental care, or prescription medicines. AHS-7 Increase the proportion of persons who receive appropriate evidence-based clinical preventive services. AHS-8 Increase the proportion of persons who have access to rapidly responding pre-hospital emergency medical services (basic life support, advanced life support).
Access to Health Services Topic Areas AHS-9 Reduce the proportion of hospital emergency department visits in which the wait time to see an emergency department clinician exceeds the recommended timeframe (all visits, immediate, emergent, urgent, & semi-urgent).
Dimensions of AccessAvailability-fit between service capacity and individual’srequirements (Shi & Singh, 2008).Examples:• Primary or preventive services available• Transportation, language, & social services available• Sufficient specialists• 24/7 availability of primary care servicesAccessibility-fit between locations and providersExamples:• Private/Public Transportation• Disabled/Elderly accessibility• Payment Options (Medicare, Medicaid, cash)
Dimensions of AccessAffordability-individual’s ability to pay.Examples:• High insurance premiums• Co-payments/deductibles reasonable• Prescription prices affordabilityAccommodation-the fit between how resources areorganized to provide services and the individual’s abilityto use the arrangement.Examples:• Appointment availability; Office hours compatibility• Routine appointments within 1 week; walk-ins services• Urgent cases seen within 1 hour; non-emergency within 1 day
Dimensions of AccessAcceptability-compatibility between patients’ attitudesabout providers’ personal and practice characteristics,and providers’ attitudes toward their clients’ personalcharacteristics and values.Examples:• Waiting time for scheduled appointments• Patients encouraged to ask questions and review records.• Acceptance of patients/providers regardless of race, religion, or ethnic origin.
Barriers to Access Geography Financing Culture Race Language (Shi & Singh, 2010)
Persons Likely to Face Access Problems People without health insurance Minorities Low-income individuals People with little formal education People with special needs/Disability People with chronic illnesses
Solution to Access DisparityPatient Protection and Affordable Care Act (Democrats, 2011):• Quality, affordable health care for all Americans• The role of public programs• Improving quality/efficiency of health care• Prevention of chronic disease and improving public health• Health care workforce• Transparency/program integrity• Improving access to innovative medical therapies• Community living assistance services and supports• Revenue provisions
ReferencesDemocrats.Senate.gov. (2011). Responsible reform for the middle class: The patient protection and affordable care act, detailed summary. Retrieved from http://dpc.senate.gov/healthreformbill.Shi, L. & Singh, D.A. (2010). Essentials of the U.S. health care system (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.Shi, L. & Singh, D.A. (2008). Delivering health care in America: A systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers.