1. Overview of the Management of Vulnerable and Underserved Populations

2. Cost, Quality, Access to Care

3. Introduction
Certain populations in the United States face greater challenges in accessing timely and needed health care services
They are at risk for poor physical, psychological and/or social health

4. Underserved Areas & Populations

5. National Budget Expenditures

6. Terminology These populations are called: Underserved populations
Medically underserved
Medically disadvantaged
Underprivileged
American under classes

7. Population Health Issues

8. Introduction Their vulnerability is due to:
Unequal social, economic, health and geographic conditions
They consist of:
Racial and ethnic minorities
Uninsured children
Women
Those living in rural areas
Homeless
Mentally Ill
Chronically ill and disabled
HIV/AIDS patients

9. Framework to Study Vulnerable Populations
Racial/Ethnic Minorities
Women and Children
Geographical Distribution: Rural Health

10. Framework to Study Vulnerable Populations
Vulnerability Model: an integrated approach to studying vulnerability
Vulnerability: denotes susceptibility to negative events
In health care, vulnerability is the likelihood of experiencing poor health or illness

11. Framework to Study Vulnerable Populations
Poor health is compounded for problems along multiple dimensions
Vulnerability represents the interaction effects of multiple factors over which many do not have control

12. Framework to Study Vulnerable Populations
Vulnerability is determined by a convergence of:
Predisposing
Enabling
Need
Characteristics at both the individual and ecological level
They converge and determine access to care and influence individuals’ risk of contracting illness

13. Framework to Study Vulnerable Populations
Understanding vulnerability as a combination or convergence of disparate factors is preferred over studying individual factors separately

14. Framework to Study Vulnerable Populations
The Vulnerability Model has distinctive characteristics:
It is comprehensive, including individual and ecological attributes of risk
It focuses on the attributes of vulnerability for the total population rather than on vulnerable traits of subpopulations

15. Framework to Study Vulnerable Populations
It emphasizes the convergence of vulnerability
Multiple vulnerable traits may lead to cumulative vulnerability that is additive or multiplicative

16. Framework to Study Vulnerable Populations
Attributes that predispose vulnerability include:
Demographic characteristics
Belief Systems
Social Structures variables
These attributes influence vulnerability status
They are associated with social position, status, access to resources, health behaviors and variations in health status

17. Race/Ethnic Minorities
In 1997 The U.S. Office of Management and Budget (OMB) included race and ethnicity to reflect diversity
Minimum categories of race include: Black, Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander and White
OMB included 2 ethnicities: Hispanic and Latino

18. Racial/Ethnic Minorities

19. Racial/Ethnic Minorities
Significant differences exist across the various racial/ethnic groups on health
Minority race and ethnicity usually serves as a proxy for factors such as: socioeconomic status, language ability, or cultural behaviors that are correlated with health status and health care experiences
Racial/ethnic minorities have poorer access, receive poorer-quality care and greater deficits in health status.

20. Racial/Ethnic Minorities
Consistently over decades of research:
Minorities have poor access to health services compared with white counterparts even after considering insurance, socioeconomics, and health status
The most commonly used measure of access is whether or not a person has a regular or usual source of care

21. Vulnerable Women and Children

22. Women and Children
Women in the U.S. enjoy a life expectancy almost eight years longer than that of men, but they:
-Have a higher prevalence of health problems over their lifetime
-Develop more acute and chronic illnesses resulting in more short and long term disabilities

23. Women and Children
Have a higher percentage of deaths at all ages for heart disease and stroke
Have the highest growing population diagnosed with AIDS
Suffer greater morbidity and poorer health outcomes
Differences between men and women are equally pronounced for mental illness

24. Women and Children
Children’s health has unique aspects of delivery such as: developmental vulnerability, dependency, and patterns of morbidity and mortality
Developmental vulnerability refers to: the rapid and cumulative physical and emotional changes that characterize childhood and the effects that illness, injury or untoward family and social circumstances can have on a child’s life.

25. Women and Children
Dependency means: the special circumstances children face where others have to recognize and respond to their health needs.
Children are increasingly affected by “new morbidities” such as:
-Drug and alcohol abuse
-Family and neighborhood violence
-Emotional disorders
-Learning problems

26. Rural Health Care

27. Geographic Distribution: Rural Health
Poverty: is consistent in rural areas and affects access
Geographic mal-distribution creates a shortage of health care professionals in rural settings which is another dimension of poor health care delivery
Rural populations face greater barriers in access to care

28. Geographic Distribution: Rural Health
To improve access in rural America there is:
The National Health Service Corps
Health Manpower Shortage Areas
Medically Underserved Areas
Community and Migrant Health Centers
Rural Health Clinics Acts

29. Enabling Characteristics
These include:
Socioeconomic status
Individual assets
Mediating factors

30. Enabling Characteristics
Socioeconomic status is associated with social position, access to resources, variations in health status, income, education, employment status and occupation
Individual assets (human capital) contributes to one’s ability to be self-sufficient
Mediating factors are associated with the use of health care services (e.g. health insurance, access to and quality health care)

31. Enabling Characteristics
Uninsured tend to:
Be poor and less educated
Work in part-time jobs and/or are employed by small firms
Be younger (25-40)
Be ethnic minorities

32. Enabling Characteristics
Homelessness
The homeless face several barriers to adequate and appropriate health care:
Financial barriers
Problems in satisfying eligibility requirements for health insurance
Transportation
Lack of sanitation, a stable place to store medicines
Inability to buy/get nutritious food

33. Enabling Characteristics
Federal Initiatives to Eliminate Socioeconomic disparities
Programs that have helped eliminate socioeconomic differences:
-Community Health Center Program
-National Health Service Corps
-Public Housing Primary Care Program
-Health Schools, Health Communities Program
-Health Care for the Homeless Program

34. Need Characteristics
Mental Health
Chronic Illness/Disability
HIV/AIDS

35. Need Characteristics
Self-perceived or professionally-evaluated health status refers to:
-self-perceived physical and mental health status and diagnoses of disease and illness from a health professional

36. Mental Health

37. Mental Health
Mental illness ranks second, after ischemic heart disease, as a burden on health and productivity
Mental illness is a risk factor for death from suicide, cardiovascular disease and cancer.

38. Mental Health
Most mental health services are provided in the general medicine sector, rather than through formal mental health specialist services
This is a concept first described by Regier and colleagues as the de facto mental health service system

39. Mental Health
The nation’s mental health system is composed of two subsystems:
One, primarily for individuals with insurance coverage or private funds and
The other for those without private means of coverage.

40. Chronic Illness/Disability

41. Chronic Illness/Disability
Chronic conditions are characterized by persistent and reoccurring health consequences lasting over a long period, which are generally irreversible
Chronic illness and disability pose unique challenges to a health car m m l;e system that is primarily oriented towards treating acute illness.

42. Quality Outcomes

43. References Benson, K (2010). Winthrop University
King & Wheeler (2007). Medical Management of Vulnerable and Underserved Patients. McGraw Hill.