Access to Health Care in U.S: Problems and the Bottom Line
Access encompasses both the ease and timeliness with which health services can be obtained (Office of Health Care Access, 1999; Millman, 1993). Metrics of measuring access to health services include:
Having health insurance,
Adequate income, and
A regular primary care provider or
Other regular source of care (U.S. Department of Health and Human Services, 2000).
Utilization of certain clinical preventive services, such as, early prenatal care, mammography, and Pap tests, can also indicate better access to services.
Rate of avoidable hospital admission
Health care models:
Purely private enterprise: Exist in poorer countries with sub standard health care dominated by private clinics for wealthier population.
In almost all the countries, a private system exists in addition to Government health care system (such as Medicare and Medicaid in U.S). This is sometimes referred to as Two-tier health care.
The other major models are public insurance systems:
o Social Security Health Care model where workers and their families are insured by the State.
o Publicly funded health care model, where the residents of the country are insured by the State.
o Social Health Insurance, where the whole population or most of the population is a member of a sickness insurance company.
Models for access: access to health services can be impeded broadly by:
Affordability: Economic barriers (no insurance, poverty),
Availability: Supply and distribution barriers (inadequate or inappropriate services or primary care providers, geographic unavailability due to difficult infrastructure);
Unavailability of services, lack of transportation and other infrastructure), and
Language and cultural barriers.
Discussion:
A. Insurance coverage:
Approximately 85% of Americans have health insurance.
Approximately 60% obtain health insurance through their place of employment or as individuals,
Various government agencies provide health insurance to 25% of Americans.[3].
In 2004, 45.8 million (15.7%) Americans were without health insurance [1].
According to 2000 U.S. census data [2], the percentage of large firms (200 employees or more) offering health benefits to its retirees fell between 1988 and 2001 (excepting a spike in 1995).
Although most types of health insurance cover common treatment services and screening and diagnostic tests, many preventive services and interventions are not covered. For example, while most health insurers will pay to treat emphysema, lung cancer, and other tobacco-related diseases, for example, few will reimburse for smoking cessation programs or medications.
B. Economic condition:
Cost is a barrier. Cost is more likely to affect persons:
Of Hispanic ethnicity,
To affect unmarried persons,
Those who did not graduate from high school, were four times more likely than college graduates to experience cost barriers to health care,
People with income under $25,000
C. Availability:
Access barrier is intense in areas where the need is high but capacity of existing providers is insufficient.
Hispanic is less likely than non-Hispanic respondents to have health-care coverage (76.2% versus 90.6%),
They have one or more regular personal health-care providers (68.5% versus 84.1%), or
They have a regular place of care (93.4% versus 96.2%).
Hispanic has needs of medical care, but can not obtain it (6.5% versus 5.0%).
Hispanics also are significantly less likely to be screened for blood cholesterol and for breast, cervical, and colorectal cancers and to receive a influenza / pneumococcal vaccination.
D. Language factor:
Language can be an obstacle to health care access for:
People who do not speak English and
For the deaf and hearing impaired.
According to the 1990 U.S. Census, about nine percent of Connecticut