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Access to Health Care in America (1993) / Chapter Skim
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4. Future Indicators
Pages 130-136

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From page 130...
... Box 4-1 lists the indicator topics that the committee has identified for future development. The topics were raised in the context of committee discussion either as concerns about access to a particular type of personal health service that had been omitted from the basic list or as concerns about a potentially vulnerable population group or a disease category.
From page 131...
... For instance, the broad group of alcohol and substance abusers can include high-risk mothers with fetal alcohol syndrome, intravenous drug users with AIDS, mentally ill substance abusers, drug users who attempt suicide, addictive families suffering domestic abuse, homeless people with substance abuse problems, and substance-abusing refugees. Once a topic has been selected, the major challenge is to conceptualize an identifiable personal health service to serve as a utilization indicator and as an outcome measure that can be related to use or lack of use.
From page 132...
... Because of the inadequacies of private health insurance, it is believed that a substantial number of disabled persons are forced to obtain supplemental security income or social security disability insurance in order to have health insurance coverage. The current set of indicators captures one dimension of disability in its measurement of the use of physician services by those in poor to fair health.
From page 133...
... For example, one of the Healthy People 2000 objectives calls for the nation to "increase to at least 30 the number of states in which at least 50 percent of the children identified as neglected or physically or sexually abused receive physical and mental evaluation with appropriate followup as a means of breaking the intergenerational cycle of abuse." There are few patient outcome studies on the impact of medical interventions for battered women, but it seems clear that, at a minimum, referral to supportive services outside the personal health care system ought to be part of a standard of care. Another facet of developing an indicator must be consideration of the potential barriers to access to services and how they might be measured.
From page 134...
... Differing patterns of emergency department use by income and issues of inappropriate transfer among hospitals also raise questions about equity that might be monitored. POST-ACUTE-CARE SERVICES FOR THE ELDERLY Systemwide utilization data to track the elderly through parts of the health care system are not readily available (Denser, 1987)
From page 135...
... Today, in comparison, their share of the rapidly growing burden of health care expenditures has begun to shrink, although it is still sizable. On the one hand, third-party payment has grown to surpass out-of-pocket payment as the major revenue source for prescriptions (Schondelmeyer and Thomas, 1990~.
From page 136...
... Health and Health Care of Vulnerable Populations. San Francisco: Jossey-Bass.


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