1. Intro to US Health System Chapter 3: Access Dr. Tracey Lynn Koehlmoos HSCI 678

2. Intro to US Health System Defining 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, Acceptibility

3. Intro to US Health System Cost-Quality-Access ACCESS QUALITYCOST

4. Intro to US Health System Dimensions of Access Geographic: transportation, rural areas Temporal: provider hours, waiting time Physical: wheelchair access, telemedicine Sociocultural: language barriers, beliefs Financial: Health Insurance (#1 barrier)

5. Intro to US Health System Factors Effecting Access Predisposing: Individual demographics –Gender, Age, Education, Race/Ethnicity –Occupation Need: perceived health/perceived illness Enabling: –Convenience, income, insurance coverage –System characteristics

6. Intro to US Health System Private 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 Insurance

7. Intro to US Health System Public 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 Insured

8. Intro to US Health System Other Govt. Health Insurance Veterans Affairs Department of Defense (Tricare) Indian Health Service Prison Health Service

9. Intro to US Health System The 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/taxes

10. Intro to US Health System Who 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 insurance

11. Intro to US Health System Proposals 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.

12. Intro to US Health System Conclusion 20% of US has limited access to healthcare Those without healthcare at greatest risk Major change is unlikely