Access to health care in America / Committee on Monitoring Access to Personal Health Care Services, Institute of Medicine ; Michael Millman, editor.

Format:

Book

Author/Creator:

Institute of Medicine (U.S.). Committee on Monitoring Access to Personal Health Care Services.

Contributor:

Millman, Michael L.

Language:

English

Subjects (All):

Health services accessibility--United States--Evaluation.

Health services accessibility.

Medical care--United States.

Medical care.

Physical Description:

x, 229 p. : ill.

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1993.

Language Note:

English

Summary:

Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators. This useful volume defines a set of national objectives and identifies indicators--measures of utilization and outcome--that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location. The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring. This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.

Contents:

Access to Health Care in America

Copyright

Contents

Summary

GENERAL CONCLUSIONS ON THE STATE OF ACCESS

DEFINING ACCESS

THE COMMITTEE'S INDICATORS AND PROGRESS TOWARD ACCESS OBJECTIVES

Objective 1: Promoting Successful Birth Outcomes

Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases

Objective 3: Early Detection and Diagnosis of Treatable Diseases

Objective 4: Reducing the Effects of Chronic Disease and Prolonging Life

Objective 5: Reducing Morbidity and Pain through Timely and Appropriate Treatment

RECOMMENDATIONS

1 Introduction

BACKGROUND

DEVELOPING A SET OF INDICATORS

RELATIONSHIP OF ACCESS MONITORING TO OTHER RELEVANT ACTIVITIES

MAJOR DATA SOURCES: THEIR USES AND LIMITATIONS

Strengths and Weaknesses

Vital Statistics

Surveys

Hospital Discharge Data

Tumor Registries

Reportable Diseases

Claims Data

CROSSCUTTING ISSUES

Race/Ethnicity

Timeliness

REFERENCES

2 A Model for Monitoring Access

MEASURING ACCESS

Indicators

Utilization Indicators

Outcome Indicators

Utilization and Its Relationship to Health Care

Mediating Factors

Barriers to Access

Structural Barriers

Financial Barriers

Personal and Cultural Barriers

The Relationship of Access Barriers to Indicators

3 Using Indicators to Monitor National Objectives for Health Care

OBJECTIVE 1: PROMOTING SUCCESSFUL BIRTH OUTCOMES

Utilization Indicator: Adequacy of Prenatal Care

Measuring the Indicator

Trends in the Data

Recommendations

Outcome Indicator: Infant Mortality

Outcome Indicator: Low Birthweight

Outcome Indicator: Congenital Syphilis

Measuring the Indicator.

Trends in the Data

OBJECTIVE 2: REDUCING THE INCIDENCE OF VACCINE-PREVENTABLE CHILDHOOD DISEASES

Utilization Indicator: Preschool Immunization

Outcome Indicator: Incidence of Vaccine-Preventable Childhood Diseases

OBJECTIVE 3: EARLY DETECTION AND DIAGNOSIS OF TREATABLE DISEASES

Utilization Indicators: Breast and Cervical Cancer Screening Procedures

Outcome Indicator: Incidence of Late-Stage Breast and Cervical Cancers

OBJECTIVE 4: REDUCING THE EFFECTS OF CHRONIC DISEASES AND PROLONGING LIFE

Utilization Indicator: Continuing Care for Chronic Diseases

Utilization Indicator: Use of High-Cost Discretionary Care

Outcome Indicator: Avoidable Hospitalization for Chronic Diseases

Outcome Indicator: Access-Related Excess Mortality

OBJECTIVE 5: REDUCING MORBIDITY AND PAIN THROUGH TIMELY AND APPROPRIATE TREATMENT

Utilization Indicator: Percentage of Healthy Individuals Who Do Not Contact a Physician During an Acute Episode of Illness

Recommendation

Utilization Indicator: Dental Services

Outcome Indicator: Avoidable Hospitalization for Acute Conditions

REFERENCES.

4 Future Indicators

ACCESS TO HEALTH CARE FOR PEOPLE WITH DISABILITIES

FAMILY VIOLENCE

EMERGENCY SERVICES

POST-ACUTE-CARE SERVICES FOR THE ELDERLY

PRESCRIPTION DRUGS

5 Recommendations

Crosscutting Recommendations

State and Local Monitoring

The Federal Role

Racial and Ethnic Differences

FUTURE STEPS

Objective 1: Promoting Successful Births

Indicator: Prenatal Care

Indicator: Infant Mortality

Indicator: Low Birthweight

Indicator: Congenital Syphilis

Indicator: Preschool Immunization

Indicator: Incidence of Vaccine-Preventable Childhood Diseases

Indicator: Breast and Cervical Cancer Screening Procedures

Indicator: Incidence of Late-Stage Breast and Cervical Cancers

Objective 4: Reducing the Effects of Chronic Diseases and Prolonging Life

Indicator: Continuing Care for Chronic Diseases

Indicator: High-Cost Discretionary Care

Indicator: Avoidable Hospitalization for Chronic Diseases

Indicator: Access-Related Excess Mortality

Indicator: Acute Medical Care

Indicator: Dental Services

Indicator: Avoidable Hospitalization for Acute Conditions

REFERENCE

APPENDIXES

A Developing Indicators of Access to Care: The Case for HIV Disease

ROBERT WOOD JOHNSON FOUNDATION AIDS HEALTH SERVICES PROGRAM AND EVALUATION

ISSUES IN ASSESSING ACCESS TO PERSONAL HEALTH CARE

Insurance Coverage

Provider Reimbursement Rates

Investment in Resources for Treating HIV Disease

Lack of a Primary Source of Care

Lack of Appropriate Service Providers.

Distance from care Providers

Extended Waiting Times for Providers

Personal Barriers

Attitudinal Barriers

VIABILITY OF DEVELOPING ACCESS INDICATORS FROM EXISTING DATA SETS

Decreased Mortality Using Case-Finding

Reduced Mortality Using Medical Management

Reduced Morbidity and Improved Function

CONCLUSION

B Developing Indicators of Access to Care: Waiting Lists for Drug Abuse Treatment

METHODS

THE NUMBER OF PERSONS ON WAITING LISTS

''THERE ARE NO REAL WAITING LISTS FOR TREATMENT

WAITING LISTS UNDERESTIMATE UNMET DEMAND

SHOULD THERE BE WAITING LISTS?

EMPIRICAL STUDIES OF WAITING LIST BEHAVIOR

DISCUSSION

FINAL COMMENT

C Developing Indicators of Access to Care: The Case for Migrants and the Homeless

MIGRANT HEALTH STATUS

HEALTH STATUS OF THE HOMELESS

D "Ambulatory-Care-Sensitive" Conditions and "Referral-Sensitive" Surgeries

Index.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references and index.

ISBN:

9786610211562

9781280211560

1280211563

9780309584661

0309584663

9780585025452

0585025452

OCLC:

923262697