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Chapter 3: AccessDefining AccessCost-Quality-AccessDimensions of AccessFactors Effecting AccessPrivate Health InsurancePublic or Social InsuranceOther Govt. Health InsuranceThe UninsuredWho are the Uninsured?Proposals to Expand CoverageConclusionIntro to US Health SystemChapter 3: AccessDr. Tracey Lynn KoehlmoosHSCI 678Intro to US Health SystemDefining Access•No right to health care in US•Fit of services to needs of clients•Ability to enter into use of services•FIVE factors:–Availability, Accessibility, Accommodation–Affordability, AcceptibilityIntro to US Health SystemCost-Quality-AccessACCESSQUALITY COSTIntro to US Health SystemDimensions of Access•Geographic: transportation, rural areas•Temporal: provider hours, waiting time•Physical: wheelchair access, telemedicine•Sociocultural: language barriers, beliefs•Financial: Health Insurance (#1 barrier)Intro to US Health SystemFactors Effecting Access•Predisposing: Individual demographics–Gender, Age, Education, Race/Ethnicity–Occupation•Need: perceived health/perceived illness•Enabling:–Convenience, income, insurance coverage–System characteristicsIntro to US Health SystemPrivate Health Insurance•71.7% of non-elderly had some form of health insurance in 2000•Private: Individual Policy/ Employer Policy•64%: Benefit of Employment•Most likely to have Private Insurance if:–White, Two Full-time Worker household–Lower income=less likely to have insurance–Small businesses, seasonal = No InsuranceIntro to US Health SystemPublic or Social Insurance•Social Security Act of 1965•Medicare: Federal program –Age 65 +, ESRD, Long Term Disability–Parts A, B, C and (now) D –44 Million Insured•Medicaid: State and Federal funding (50/50)–Categorical welfare, living with AIDS, –Low income pregnant woman, children, elderly–40.6 Million InsuredIntro to US Health SystemOther Govt. Health Insurance•Veterans Affairs•Department of Defense (Tricare)•Indian Health Service•Prison Health ServiceIntro to US Health SystemThe Uninsured•16% of US population•Where do they get care?–Emergency rooms–Public health clinics–Charity/Pro Bono/Free clinics•Enter the health care system at the most expensive point of access—put a financial burden on hospitals/community/taxesIntro to US Health SystemWho are the Uninsured?•Uninsured does not mean unemployed–15% two worker-, 56% one worker-households•3/4 White, 56% Male, most likely age19-34•28% Retail jobs; 33% Service industry•Many cannot afford premiums•Many work for companies that do not offer health insuranceIntro to US Health SystemProposals to Expand Coverage•1993 Health Services Act: failed–Expand Medicare–Reform Health Insurance Industry•Expanding Medicaid: State by State•1997 Title XXI SSA: SCHIP•Create Single Payer System: Not likely•1996 HIPAA•States: Risk Pools and State Ins. Progs.Intro to US Health SystemConclusion•20% of US has limited access to healthcare•Those without healthcare at greatest risk•Major change is


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MASON HSCI 678 - Chapter 3: Access

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