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Utilization of Preventative Medical Services: What keeps people away from complying?
by
Laura E. Miller
Benedictine Univer...
2
Abstract
Introduction: Although the lack of medical insurance often correlates with limited use of
preventative medical ...
3
Introduction
Identifying specific reasons why community residents do not obtain preventive medical
services helps to ide...
4
and policymakers need to remain focused on one question: If they will be assisting in
contributing to the increase in qu...
5
Statistical Significance will be performed on each variable and question related to a preventive
medial service. I will ...
6
The Community Health Assets and Needs Assessment (CHANA) 2011-2014 Study is a
local project that was established and is ...
7
medial services. The demographic factors analyzed are then used to identify assets and resources
that can be mobilized t...
8
equivalent entity to be a part of the Census Bureau's Participant Statistical Areas Program
(United States Census Bureau...
9
to demographic factors of gender, Hispanic or Latino identification, and race/ethnicity. I utilized
Chicago Square Test ...
10
Test of Statistical Significance. Each frequency, cross tabulation, and Chicago Square Test of
Statistical Significance...
11
was not necessary (33.9%). Table 1 further illustrates that additional reasons included 11.6% not
being able to afford ...
12
breast exam, 31.7% did not have a clinic breast exam, and 24.5% did not have a breast x-ray or
mammogram within the pas...
13
Provider did not request 8.2 3.6 5.7 4.5
Unknown or no reason 4.7 12.7 2.3 0.6
Various other reasons 1.2 5.5 3.4 1.3
So...
14
The residents of Berwyn Township have variances in frequencies of obtaining
preventative medical services in the past t...
15
services. Increasing the volume of medical information pamphlets with appropriate literature
provided to Berwyn Townshi...
16
plan. Are they aware that their co-payments are waived for preventative medical services? Or is
it even probable that B...
17
the resident survey component from the CHANA 2011-2014 Study included frequency analysis,
cross tabulations for each qu...
18
References
Centers for Disease Control and Prevention. (2013). "Community Health Assessment for
Population Health Impro...
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  1. 1. Utilization of Preventative Medical Services: What keeps people away from complying? by Laura E. Miller Benedictine University For Dr. P. Rafael Hernandez-Arias University of New Mexico August 14, 2016
  2. 2. 2 Abstract Introduction: Although the lack of medical insurance often correlates with limited use of preventative medical services, identifying additional reasons provide guidance to improve the delivery of medical services. The reasons for not attaining preventative medical service provide insights for improving the delivery and use of preventative care. Methods: This is a multi-variate analysis on the Community Health Assets and Needs Assessment (CHANA) 2011-2014 cross-sectional study with a representative sample of 441 residents in Berwyn Township, Illinois. The residential survey included questions on obtaining preventative medical services and open-ended responses for not obtaining each specific service. Additionally, demographic variables of gender, Hispanic or Latino identification, and race/ethnicity were collected identifying further significant findings. Findings: A large portion of the residents in Berwyn Township did obtain preventative medical service exams. In contrast, 20.9% did not have a physical checkup or exam within the past twelve months. Similarly, a large portion of females in Berwyn Township obtained the questioned general preventative medical services within the past twelve months averaging 44.56% compared to an average of 26.4% of males. Hispanic or Latinos were less likely to obtain all preventative medical services questioned with an average of 36.6% obtaining preventative medical services. The most common reasons why preventative medical services were not obtained was that the procedure was not necessary, not able to be paid for, and because they feel or felt fine. Implications and Conclusion: The implementation of more comprehendible medical service pamphlets and policymakers working with medical facilities to encourage preventative medical services to be obtained can allow Berwyn Township to increase the quantity of all preventative medical services. The returning findings in the information gathered and continuously presented to local stakeholders has the potential for the development of new informative medical service materials and programs for improved networking of medical providers. Keywords: Preventive medical services, Berwyn Township, Community Health Assets and Needs Assets (CHANA), comprehendible medical service pamphlets, networking of medical providers
  3. 3. 3 Introduction Identifying specific reasons why community residents do not obtain preventive medical services helps to identify what can be done by local stakeholder and policymakers to eliminating challenges in delivery and utilization of preventative medical services. Preventative medical services include examinations, immunizations, diagnostic lab tests, screenings and other services that are intended to prevent illness or detect problems before any symptoms arise (Medical Mutual of Ohio 2016). Specific reasons of why preventative medical services are not being obtained provides insight to key indicators. These key indicators are than associated with health outcomes and barriers that cause disruption in delivery and utilization of preventative medical services. The Office of Disease Prevention and Health Promotion argue that the largest barrier for obtaining preventative medical services is most commonly a lack of insurance coverage and the high cost of procedures. What other reasons are affecting individuals to not participate in obtaining preventative medical services? The Centers for Disease Control and Prevention state that individuals might not be aware of recommended preventative medical services. This encompasses social barriers such as cultural beliefs or fear that can be delay obtainment of preventative medical services. The identification of reasons why community members do not obtain preventative medical services can be disseminated to local multi-sector stakeholder and policymakers to work collaboratively towards implementation of recommendations for eliminating challenges a community faces. Although these reviews reach the general conclusion that some communities are not obtaining preventive medical services for reasons beyond having health insurance coverage, we need to remain focused on identifying these specific reasons for not obtaining preventative medical services to increase evidence-based practice recommendations. Community stakeholder
  4. 4. 4 and policymakers need to remain focused on one question: If they will be assisting in contributing to the increase in quantity of preventive medical services, are the reasons provided for not obtaining preventative medical services able to be addressed and improved upon in the future. Others have assessed the importance of obtaining preventative medical services and which services are most often not obtained. But to my knowledge, until now, no one has examined the specific reasons provided from community residents for not obtaining preventative medical services. Let alone, there has been no efforts completed towards addressing community recommendations for increasing the quantity of future preventative medical services. This leads to me to identify the specific reasons that exist within the residents of Berwyn Township that demonstrate a lack of utilization of preventative medical services. I will utilize data collected from a resident survey that was part of a community health needs assessment involving community members, organizational representatives, and researchers. Previously conducted community health assessments have utilized the same effectiveness of partners for identifying specific factors within a population. This offers the greatest insight and collaboration experience for optimal results. I will complete a multi-variate analysis to achieve my goals of identifying the specific reasons of the population not obtaining preventative medical services. I will complete this process with the use of frequency analysis for each response provided by Berwyn Township residents for not obtaining a preventative medical service. I will further want to identify significant demographic factors in relation to gender, Hispanic or Latino identification, and race/ethnicity that are contributing to the lack of utilization of preventative medical services. In order to do so I will compute cross tabulations of each preventative medical service and demographic variable. Additionally, Chicago Square Test of
  5. 5. 5 Statistical Significance will be performed on each variable and question related to a preventive medial service. I will then identify recommendations to be implemented in the community for improvements in the quantity of individuals obtaining preventative medical services. Background A systematic health assessment demonstrating a qualitative approach to determine reasons of not obtaining preventative medical services can assist to improve the health of community residents. A systematic health assessment addressing preventative medical services in a community follows a consistent pattern. This often includes open-ended questions to highlight the areas of unmet needs, specifically for obtaining preventative medical services. The use of systematic health assessments in a community can aid in rational decision making of how to utilize resources to improve local population health in the most effective and efficient ways. The key findings from a systematic health assessments are able to contribute to influencing policy, interagency collaboration, or research and developmental priorities (Wright, Williams, and Wilkinson 1998). During the examination of a systematic health assessment for how to utilize community resources, potential gaps in services necessary or warranted by a community specifically related to preventative medical services, can come arise. This permits the systematic health assessment to prompt the importance of challenges for obtaining preventative medical services. These challenges can be identified by residents in terms of reasoning, frequency, impact, and financial burdens that are seen within the explanations of reasoning provided by residents (Wright, Williams, and Wilkinson 1998). The identification and importance of the specific reasons preventative medical services are not being obtained warrants as evidence for effective interventions to take place.
  6. 6. 6 The Community Health Assets and Needs Assessment (CHANA) 2011-2014 Study is a local project that was established and is conducted by community stakeholders. CHANA has been successful in collecting data on health conditions, medical facility resources, and gaps in health needs with the administration of a systematic health assessment; a residential survey in the Berwyn Township. Berwyn Township is a suburban Cook County community to the west of downtown Chicago, and home to over 56,000 residents. Prior to the CHANA 2011-2014 Study residential survey, information was not available on residential preventative medical service utilization. CHANA was able to identify that Berwyn Townships does have medical facilities that offer preventative medical services. A local community health clinic provides several free or low-cost preventative medical services for Berwyn Township children and adult residents. Additionally, MacNeal Hospital is located in Berwyn Township providing several specialized and preventative medical services. The community academic partners conducted the residential survey to identify existing health information gaps, resident health priorities, and information to aid in the development of interventions. The information collected through the systematic health assessment of the residential survey assisted to improve the effectiveness of medical services provided and the utilization of such services in Berwyn Township. In this paper, I identify the proportion of Berwyn Township residents who did not have preventative exams in the previous year and the specific explanations about why the residents did not obtain the preventative exams. This analysis is able to be used in promoting recommendations within the community for improvements in residents obtaining preventative medial services. I use specific variables and covariates to identify the health status of the population. This information will then be applied to improvement areas for preventative medial services. I analyze demographic factors that contribute to the lack of utilization in preventative
  7. 7. 7 medial services. The demographic factors analyzed are then used to identify assets and resources that can be mobilized to address interventions or program developments within Berwyn Township for population health improvements (Centers for Disease Control and Prevention 2013). My conducted findings from the CHANA 2011-2014 Study are able to target explicit reasons that are encumbering Berwyn Township residents from obtaining preventative medical services. The identified encumbering results can be used in recommendations to local stakeholder and policymakers to be implemented in the community. Methods In the analyzes, I employed data from the residential survey component of the CHANA 2011–2014 Study. The survey involved a multi-stage cluster design and gathered observations about how community residents experience health, illness, and medicine. The residential survey permits generalization of the information gathered Berwyn Township residents. The residential survey for the CHANA 2011-2014 Study, comprised of 292 questions, was administered to Berwyn Township residents in winter 2013 and spring 2014 to obtain valuable information in relation to community health factors. Information collected from each participant included nine sections of information topics: residential unit and neighborhood, use of medical services and medicines, diagnosed physical and mental conditions, health knowledge and practices, children health, demographic information and immigrant health. All participants that completed the residential survey were residents of Berwyn Township in respect to their location aligning with the United States Census Bureau tracts. A total of 441 residential survey participants, representing 0.8% of Berwyn Township’s population, resided in one of the ten census tracts in Berwyn Township. Each census tract averages 5,677 residents. The census tracts allowed these small relatively permanent statistical subdivisions of a county or
  8. 8. 8 equivalent entity to be a part of the Census Bureau's Participant Statistical Areas Program (United States Census Bureau 2012). This permitted the residential survey of the CHANA 2011- 2014 Study to provide the same constant set of geographic units for the presentation of statistical data collected. I chose to compare the residential survey respondents that did not obtain appropriate preventive medical services within the past twelve months to specific demographic factors. I identified the questions and answers for preventative medical services within section five of the residential survey: health knowledge and practices. I gathered the data on a total of nine questions that related to Berwyn Township residents not obtaining preventive medical services. Four questions were asked to both females and males. An additional four questions were only asked to females and one additional question was only asked to males. For the open-ended questions I utilized, I captured explanations as stated by the respondents, which were recoded into sixteen categories. I further explored the residential survey for residents not obtaining preventative medical services by demographic factors of gender, Hispanic or Latino identification, and race/ethnicity. I used IBM Statistical Package for the Social Science (SPSS) Statistics version 24 software (SPSS Inc., Chicago, Illinois, USA) for all statistical analysis of the CHANA 2011-2014 Study. I conducted majority of the analysis with frequency and cross tabulation descriptive reports. This allowed me to compare all responses for each specific variable selected. I additionally performed Chicago Square Test of Statistical Significance with 2 degrees of freedom (df), a p value <0.05, and a 95% confidence level. I utilized Chicago Square Test of Statistical Significance for all residential survey respondents not obtaining preventative medial services within the past twelve months in relation
  9. 9. 9 to demographic factors of gender, Hispanic or Latino identification, and race/ethnicity. I utilized Chicago Square Test of Statistical Significance for all preventative medial services questioned with gender identification of female or male which lead to me discover that gender was statistically significant for not obtaining a physical checkup or exam, an eye exam, a dental exam, and exam of the colon. I further analyzed Chicago Square Test of Statistical Significance for all preventative medial services questioned with Hispanic or Latino identification. My results concluded that Hispanic or Latino identification was statistically significant for not obtaining an eye exam, dental exam, gynecological exam, self-breast exam, and clinic-breast exam. Hispanic or Latino identification was not statistically significant for not obtaining a physical checkup or exam, exam of the colon, breast x-ray or mammogram, and prostate exam. I administered the method of analysis of Chicago Square Test of Statistical Significance for all preventative medial services questioned with race/ethnicity. Race/ethnicity projected identical results in my statistical significance analysis for being statistically significant for not obtaining an eye exam, dental exam, gynecological exam, self-breast exam, and clinic-breast exam and not statistically significant for not obtaining a physical checkup or exam, exam of the colon, breast x-ray or mammogram, and prostate exam. The statistical significance of preventative medical services based and demographic information for gender, Hispanic or Latino identification, and race/ethnicity is further illustrated in Tables 1, 2 and 3 with signifying asterisks (*). Findings The CHANA 2011-2014 Study residential survey was able to identify specific reasons provided by the population for not obtaining a physical checkup or exam, an eye exam, a dental exam, and exam of the colon within the past twelve months. This was accomplished with descriptive tests conducted in SPSS. I utilized frequencies, cross tabulations, and Chicago Square
  10. 10. 10 Test of Statistical Significance. Each frequency, cross tabulation, and Chicago Square Test of Statistical Significance specifically analyzed one preventative medical service not being obtained in association with a single identified demographic variable of gender, Hispanic or Latino identification, and race/ethnicity. This continually process of frequencies, cross tabulation, and Chicago Square Test of Statistical Significance allowed for efficient and effective analysis of the Berwyn Township residential survey respondents in relation to preventative medical services. A large portion of the residents in Berwyn Township did obtain preventative medical service exams. In contrast, Table 1 illustrates that 20.9% did not have a physical checkup or exam within the past twelve months. Similarly, a large portion of females in Berwyn Township obtained the questioned general preventative medical services within the past twelve months averaging 44.56% compared to an average of 26.4% of males that did obtain the general preventative medical services. Additionally, an average of 56.5% of White Berwyn Township residents obtained the general preventive medical procedures questioned compared to other race/ethnicities at an average of 23.4%. But what about those who did not obtain the questioned general preventative medical services within the past twelve months? What are their demographics and reasons for not obtaining preventative medical services? I analyzed the proportion of the residents that did not obtain a general preventative medial service and their reasoning’s for why it was not obtained. Table 1 illustrates that 20.9% of respondents did not obtain a physical, 42.2% did not have an eye exam, 39.7% did not have a dental exam, and 79.6% did not have a colon exam. A large portion of the population not obtaining preventative medical services were those of Hispanic identification (54.2%) and another race/ethnicity other than White (54.0%). I determined that a large portion of the population that did not obtain a specific preventative medical procedure identified that they felt it
  11. 11. 11 was not necessary (33.9%). Table 1 further illustrates that additional reasons included 11.6% not being able to afford the procedure and 8.2% stated that they felt or was fine. A very minimal quantity, 5.3% reflected in Table 1, of the respondents identified not having health insurance as a factor for not obtaining a preventative medical service. Table 1: Distribution of the Population in Berwyn Township that Did Not Have Preventative Medical Exams, 2013–2014 N=441 Physical Eye Dental Colon Did not have an exam 20.9 (n=92) 42.2 (n=186) 39.7 (n=175) 79.6 (n=351) Demographic characteristics Male 44.6* 33.5* 35.4* 34.8* Female 55.4* 63.4* 64.0* 64.7* Hispanic 63.0 50.5* 49.7* 53.6 Other races 60.9 48.4 52.3* 54.4* White 39.1 51.6 47.7* 45.6* Reasons for not having exams Age too young or old --- 1.1 --- 19.4 Because felt or was fine 17.4 8.1 6.3 1.1 Could not afford it 16.3 9.7 14.9 5.4 Did not have the time 10.9 5.4 5.7 3.4 Done two+ years ago 2.2 7.0 1.7 9.1 Evaded the procedure 1.1 0.5 2.9 1.7 Felt it was not necessary 21.7 44.6 38.3 31.1 Had not seen a doctor 7.6 6.5 9.1 9.7 Looking for a provider 2.2 1.1 1.1 0.6 Needed information --- --- --- 0.2 No medical insurance 7.6 4.3 4.0 2.0 Not covered by insurance 4.3 7.0 8.0 2.0 Provider did not request 2.2 --- --- 8.0 Unknown or no reason 3.3 4.3 3.4 5.7 Various other reasons 3.3 0.5 4.6 0.6 Source: Community Health Assets and Needs Assessment 2011–2014 Study Residential Survey Note: (*) Indicates statistical significance at alpha <0.05 Females responded whether they had obtained a gynecological exam, self-breast exam, a clinic-breast exam, and a breast x-ray or mammogram in the past twelve months. A large portion of the female population did obtain the questioned preventative medical services. But then again Table 2 illustrates that 30.6 % did not have a gynecological examination, 19.8% did not have a
  12. 12. 12 breast exam, 31.7% did not have a clinic breast exam, and 24.5% did not have a breast x-ray or mammogram within the past twelve months. Hispanic and females of other races were commonly not obtaining the questioned preventative medical services in the past twelve months. Table 2 illustrates that a large portion of 63.0% of female Hispanics did not have a did not have a gynecological exam, 50.5% did not have a breast exam, 49.7% did not did not have a clinic breast exam, and 54.4% did not have a breast x-ray or mammogram within the past twelve months. Table 2 further highlights that 60.9% of other race/ethnicity females did not have a did not have a gynecological examination, 48.4% not have a breast exam, 52.3% did not did not have a clinic breast exam, and 54.4% did not have a breast x-ray or mammogram within the past twelve months. The most common reasons for females not obtaining these preventative medical services are exemplified in Table 2 that 22.4% felt it was not necessary, 11.5% did not see a doctor and that 8.6% could not afford the procedure. Table 2: Distribution of the Female Population in Berwyn Township that Did Not Have Preventative Medical Exams, 2013–2014 N=441 Gynecological Self-breast Clinic breast Breast X-ray/ Mammogram Did not have an exam 30.6 (n=85) 19.8 (n=55) 31.7 (n=88) 24.5 (n=108) Demographic characteristics Hispanic 35.3* 38.2* 46.6* 52.9 Other races 42.4* 40.0* 46.6* 52.9 White 57.6* 60.0* 53.4* 47.1 Reasons for not having exams Age too young or old 7.1 10.9 10.2 35.5 Because felt like or was fine --- --- 4.5 --- Could not afford it 10.6 --- 5.7 9.7 Did not have the time 4.7 1.8 4.5 1.3 Done two+ years ago 4.7 3.6 6.8 7.7 Evaded the procedure 3.5 --- 5.7 1.3 Felt it was not necessary 28.2 27.3 22.7 19.4 Had not seen a doctor 15.3 7.3 14.8 8.4 Looking for a provider 3.5 --- 1.1 1.3 Needed information 2.4 12.7 1.1 1.9 No medical insurance 5.9 5.5 5.7 2.6 Not covered by insurance --- --- 4.5 4.5
  13. 13. 13 Provider did not request 8.2 3.6 5.7 4.5 Unknown or no reason 4.7 12.7 2.3 0.6 Various other reasons 1.2 5.5 3.4 1.3 Source: Community Health Assets and Needs Assessment 2011–2014 Study Residential Survey Note: (*) Indicates statistical significance at alpha <0.05 Males responded whether they have had a prostate exam in the past twelve months. Unlike the female population, 65.9% of males did not obtain a prostate exam. Table 3 illustrates that 74.7% were Hispanic males and 63.9% were other race/ethnicity males not obtaining a prostate exam. The specific reasons for not obtaining a prostate exam was that 35.2% were too young or old, 25.0% felt it was not necessary, and 9.3% had not seen a doctor. Table 3: Distribution of the Female Population in Berwyn Township that Did Not Have Preventative Medical Exams, 2013–2014 N=441 Prostate Did not have an exam 65.9 (n=108) Demographic characteristics Hispanic 74.7 Other races 63.9 White 36.1 Reasons for not having exam Age too young or old 35.2 Because felt like or was fine 0.9 Could not afford it 4.6 Did not have the time 1.9 Done two+ years ago 2.8 Evaded the procedure 2.8 Felt it was not necessary 25.0 Had not seen a doctor 9.3 Looking for a provider --- Needed information 4.6 No medical insurance 0.9 Not covered by insurance 1.9 Provider did not request 3.7 Unknown or no reason 3.7 Various other reasons 2.8 Source: Community Health Assets and Needs Assessment 2011–2014 Study Residential Survey Note: (*) Indicates statistical significance at alpha <0.05 Implications
  14. 14. 14 The residents of Berwyn Township have variances in frequencies of obtaining preventative medical services in the past twelve months when analyzing demographic variables of gender, Hispanic or Latino identification, and race/ethnicity. I conclude: A large portion of the population did obtain general preventative medical services of physical checkup or exams, eye exams, dental exams, and exams of the colon. Females were more likely to not obtain their specific preventative procedure medical services of a gynecological exams, self-breast exams, clinic-breast exams, and a breast x-ray or mammogram. The female population could be less probable for obtaining preventative medical services if they are ensuring that their children are obtaining them as well. These additional tasks of childhood preventative care and immunization schedules might be taking up majority of a female’s time or financial responsibilities. Hispanic or Latinos were less likely to obtain all preventative medical services questioned. This might be due to a social language barrier of limited Spanish speaking medical providers in Berwyn Township. The most common reasons why preventative medical services were not obtained was that the procedure was not necessary, not able to be paid for, and because residents feel or felt fine. These reasons could furthermore indicate that the residents did not have the time to obtain preventative medical services within the past twelve months. Additionally, other high remarked responses included not having health insurance coverage or that the respondent did not match the age recommendations to obtain the procedure (specifically for a gynecological exam, breast x- ray or mammogram, and prostate exam). My conclusions from analyzing the CHANA 2011-2014 Study is able to demonstrate a need for an increase in comprehendible medical information pamphlets. This would consist of altering the challenging language presented in the medical information pamphlets. This can be specifically seen within the Hispanic or Latino population not obtaining preventative medical
  15. 15. 15 services. Increasing the volume of medical information pamphlets with appropriate literature provided to Berwyn Township residents could increase the rate of individuals obtaining preventative medical services. There is an association with the significant of complex medical material being communicated with patients for medical procedures. A representative study completed found that this includes an average of 114.1 difficult words and 46.3 non quantifiable phrases identified by patients per medical information pamphlet being available (Fuchs, Werner, Scheunpflug, et al. 2010). This might require for current medical information pamphlets to be revised to an appropriate comprehension reading level. This would ideally include not using a reading level above third grade standards. Additionally, most if not all medical information pamphlets should be available in Spanish at the identical comprehension reading level. These adjustments that I have identified for modifications of medical information pamphlets could simultaneously aid in providing the knowledge necessary to Berwyn Township residents not obtaining a preventative medical services. The population that responded that they feel or felt fine can acquire the knowledge needed to understand that preventative medical services are not only needed when you feel sick or ill. By providing the appropriate and accommodating comprehension reading level in the literature there will be an increase in obtaining preventative medical services based on increased knowledge of the services. The Berwyn Township residents indicating that they cannot afford a preventative medical service can be addressed with the improvements of medical facility networking conducted by local stakeholders and policy makers. All medical facilities and provided in the community providing preventative medical services do not offer affordable payments or payment plans for patients. Yet, this population that cannot afford a preventative medical service might not have the knowledge that most of the time preventative medical services are covered under their insurance
  16. 16. 16 plan. Are they aware that their co-payments are waived for preventative medical services? Or is it even probable that Berwyn Township residents that do hold private or public insurance have low incomes or functional impairments causing significant financial barriers even with health insurance coverage? This population could be charging unexpected costs of obtaining preventative medical services to their credit cards. Does this result in filing bankruptcy in the future? Stakeholders and policymakers need to identify and address gaps in health plans being utilized by Berwyn residents. This can include collaborating with local medical facilities and MacNeal Hospital to examine the types of health insurance plans that are being utilized. By establishing a networking program for Berwyn Township medical organizations and providers the population unable to afford preventative medical services can be provided financial assistance and still obtain preventative medical services as needed. This can include options of lowering payments of each preventative medical service or making payment plans available. Local stakeholders, policymakers and medical facilities can look at additional safety net medical providers in Berwyn Township that offer lower costing preventative medical services. This will allow accommodations for the population facing increased financial obligations. Berwyn Township health communities and organizations should further examine if there are any possibilities for partnering with providers or locations offering free or reduced-priced health services. This can slow the growth of unexpected healthcare costs while the population can still obtain preventative medical services in a timely fashion rather than delaying. Conclusion I completed this study to better examine and comprehend the utilization of preventative medical services in Berwyn Township. I probed the question of why Berwyn Township residents were not obtaining preventative medical services. The completion of my multi-variate analysis of
  17. 17. 17 the resident survey component from the CHANA 2011-2014 Study included frequency analysis, cross tabulations for each questioned preventative medical service and demographic variable of gender, Hispanic or Latino identify, and race/ethnicity, and Chicago Square Test of Statistical Significance of preventative medical services with each demographic variable. I was able to identify recommendations to be implemented in the community for obtaining improvements in the quantity of individuals obtaining preventative medical services. I told you that focusing on other explanations beyond medical insurance coverage was important for not obtaining preventative medical services. Well, in my findings, I have demonstrated why alternative explanations are important along with the implications that these alternative explanations have in understanding and improving the delivery and use of preventative medical services. This study’s purpose is to ultimately recognize specific factors that can be addressed within the community to allocate for all Berwyn Township residents to obtain preventative medical services. The reoccurring reasons identified for not obtaining preventative medical services in Berwyn Township residents can be provided to local stakeholders and policymakers for development of compensable medical service materials to increase knowledge and programs for networking of medical providers to provide the necessary preventative medical services without financial burdens.
  18. 18. 18 References Centers for Disease Control and Prevention. (2013). "Community Health Assessment for Population Health Improvement: Resource of Most Frequently Recommended Health Outcomes and Determinants." from http://wwwn.cdc.gov/CommunityHealth/PDF/Final_CHAforPHI_508.pdf. Fox, J. B. and F. E. Shaw (2014). "Relationship of Income and Health Care Coverage to Receipt of Recommended Clinical Preventive Services by Adults — United States, 2011–2012." Morbidity and Mortality Weekly Report (MMWR) 63(31): 666-670. Fuchs, J., S. Werner, et al. (2010). "Excessive medical information increase in package inserts." International Journal of Clinical Pharmacology and Therapeutics 48(December): 781-790. Medical Mutual. (2016). "The Difference Between Preventive and Diagnostic Medical Care." from https://www.medmutual.com/For-Individuals-and-Families/Healthy-Living/What-Is- Preventive-Healthcare/The-Difference-Between-Preventive-and-Diagnostic-Medical-Care.aspx. Office of Disease Prevention and Health Promotion. (2016). "Access to Health Services." from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services. United States Census Bureau. (2012). "Geography." from https://www.census.gov/geo/reference/gtc/gtc_ct.html. Wright, J., Williams, R., and Wilkinson, J.R (1998). “Development and importance of health needs assessment.” British Medical Journal 316(7140): 1310–1313. Work Group for Community Health & Development (2016). "Section 1. Developing a Plan for Assessing Local Needs and Resources."

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