1 Access to Health Care Ability to obtain health services when needed. Yaseen Hayajneh, RN, MPH, PhD

2 Iron Triad of Health Care

3 Access to Health Care

4 John Q (2002)

5 John Quincy Archibald's son Michael collapses while playing baseball as a result of a heart failure. Immediately, John Q. rushes Michael to the hospital's emergency room for a transplant. Unfortunately, the insurance would not cover his son's transplant. So in order for Michael's quick and complete recovery, John takes the emergency room hostage until the hospital agrees to do the needed transplant.

6 Access to Health Care: Definition The ability to obtain health services when needed. 2 Major Components of Access to HC Financial = Ability to pay Non-Financial = Availability of health care personnel and facilities that are: Close to where people live Accessible by transportation Culturally acceptable Capable of providing appropriate care in timely manner and in a language spoken by users.

7 Financial Barriers to Health Care

8 Lack of Insurance Health insurance is a key factor in making health care accessible.

9 Number of the Uninsured in USA Good Economy Economic Recession Escalating Cost & Recessionary Cycles

10 Why People Lack Insurance - USA Skyrocketing cost of health care Insurance became unaffordable to businesses and individuals. Destabilized Economy and Workforce More low-wage Increasingly part-time Non-unionization

11 Who are the Uninsured: Race and Ethnicity In 2002, USA 32% of Latinos 20% of African Americans 18% of Asian Americans 11% of non-Hispanic whites

12 Who are the Uninsured: Income In 2002, USA 24% of those with < $25,000 Yearly Income 8% of those with > 75,000 Yearly Income In 2002, USA 30% of those with incomes below FPL People who are poor and members of minority groups are four times as likely to be uninsured as higher income white persons.

13 Characteristics of the Uninsured, USA

14 Health Insurance and Use of Services.. 1 The simplest measurement of Access is the number of times a person uses HC services. Physician visits Hospital days Preservative services received.

15 Health Insurance and Use of Services.. 2 The uninsured are less likely to have a regular source of health care and more likely to report delays in receiving health care. The influence of health insurance on access is complicated by the factor of income, because lack of insurance is correlated with low income. Lack of insurance rather than low income is the main barrier to using health services.

16 Percentage not Getting Care Due to Cost

17 Measures of Health Outcome (Indicators) Avoidable Hospitalization Mortality rates Blood Pressure Control among hypertensive Low birth weight Neonatal deaths Appendix rupture rates …

18 Health Insurance and Health Outcomes.. 1 The uninsured suffer worse health outcomes than those with insurance. Uninsured - appendicitis are more likely…rupture Those who lost their Medicaid coverage have worse control of BP than those who retained it. Uninsured newborns have higher rates of death.

19 Health Insurance and Health Outcomes.. 2 Uninsured suffer a higher overall mortality rate than those with insurance. Uninsured adults have higher rates of in-hospital mortality compared with insured. A study found that lack of insurance increased the risk of dying by 25%.

20 under-INSURANCE Happens when health insurance coverage has limitations that restrict access to needed services. Lack of coverage for catastrophic expenses. Exclusion of coverage for pre-existing illnesses. Services not covered. Insurance deductibles and co-payments In USA, Gaps in Medicare coverage Lack of coverage for long term care (LTC)

21 The Effects of Underinsurance Cost sharing reduces the rate of ambulatory care use, especially among the poor. Lack of comprehensive insurance reduces access to health care services and may contribute to poorer health oucomes.

22 Non-Financial Barriers to Health Care

23 Non-financial Barriers to Health Care Long distance to facilities Language Literacy Cultural differences Gender Race

24 Gender & Access to Health Care Women are 25% more likely than men to report not needed health care. 50% more than men to report leaving a physician because of dissatisfaction with their care. Over twice likely to report that their physician “talked down” to them. Female physicians are more patient-centered and spend more time with their patients than male physicians. It seems that women has lower levels of access to HC than males.

25 Race and Access to Health Care There seems to be racial disparities in access to health care - USA Explanations Availability of services in minorities’ communities. Culture – Different conceptualization of issues. Communication barriers History of institutional racism and segregation.

26 Income and Health Status Income level of individuals and distribution of income within communities seems to influence the overall health of populations.

27 Access to HC and Health Status Access to HC is one determinant of health status. Other socioeconomic factors determines health status (income, education and occupations).