ACCESS TO HEALTH CARE

1

• ACCESS TO HEALTH CARE
• What are the important Questions?
• Who can get in ?
• Who gets excluded?

2
ACCESS TO HEALTH CARE

• What is the Policy aim?
• Decreasing health disparity?
• Increasing Access?
• Diverting the target?

3
ACCESS TO HEALTH CARE

• What are some measures of Access?
• National and State Survey data
• Requests for care
• Private Physicians/or LHJ Offices
• Emergency Room use
• Preventable Hospitalizations

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Part of the problem We may be looking for our
lost key underneath the streetlight Because the
light is better there, not because that is
where we lost the Key!
5
National Survey NHIS Survey National randomized
survey Includes detailed questions on
utilization, lack of access and reasons for
lack Reasonably precise but infrequent
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• Healthy People 2000 Indicators of Childrens
  Access
• Current Health Insurance 0-17
• 76 private insurance).
• 10 Medicaid
• 14.5 No coverage

7

• Healthy People 2000
• Indicators of Childrens Access
• Last visit to Doctor or Clinic or place
• for routine care?
• 1 Never seen a doctor
• 16 No routine care in last 2 years
• 6 (gt17) lacked a regular place of care
• 19 Do not receive sick care from same provider
  each time of need

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• Healthy People 2010 Goals
• Reducing to 0 the proportion of children and
  adults younger than 65 w/out health care
• Increase to 95 proportion of people with a
  specific source of ongoing primary care
• Increase to 90 who have access to pre-hospital
  emergency services
• Increase functional assessments for potential
  long term patients.

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• Washington State Population Survey (OFM Study )
• Randomized sample of WA residents
• Asked detailed questions on access to primary
  care and insurance precise, but infrequent

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BRFSS Questions on access and utilization for
state and nation based on random sample Precise,
but questions can vary from year to year
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CHARS WA state discharge abstract database Some
national studies have used abstracts to estimate
avoidable hospitalization rates as a proxy for
lacks of primary care and access Can be done more
frequently than surveys, but less precise
12
Local Health Jurisdictions Thurston County
example Used multiple measures to estimate lack
of access to care at the local level Surveys,
databases, others