Skip to main content

Access to Health Care in America (1993) / Chapter Skim
Currently Skimming:

Summary
Pages 1-18

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 1...
... to a 17-member committee of experts chosen for the Access Monitoring Project was to develop a set of indicators for monitoring access to personal health care services at the national level over time. It was envisioned that these indicators would be akin to national economic indicators the unemployment rate, new housing starts, the inflation rate, consumer confidence surveys which provide a picture of the state of the economy and how it might be changing.
From page 2...
... Nonetheless, the large proportion of the nation's resources being devoted to personal health care has provoked considerable interest in monitoring those investments from the standpoint of equity of access. The IOM committee's approach to developing indicators was to find measures that would track the use of services known to have measurable effects for example, prenatal care.
From page 3...
... The committee believes that evidence is building to demonstrate that no or inadequate health care coverage is the reason many of these people fail to obtain the timely and appropriate care that would make a difference in the state of their health. Further work is required, however, to establish solid causal linkages between the access barriers of lack of health insurance, low income, and nonfinancial factors such as culture and geographic isolation and measures of outcome such as premature death, sickness, disability, and avoidable hospitalization.
From page 4...
... In applying its definition of access, the committee sought to occupy a practical middle ground between all care that people might want or need and the belief that medical care can make an important difference in people's lives. The definition forces us to identify those areas of medical care in which services can be shown to influence health status and then to ask whether the relatively poorer outcomes of some population groups can be explained by problems related to access.
From page 5...
... THE COMMITTEE'S INDICATORS AND PROGRESS TOWARD ACCESS OBJECTIVES Objective 1: Promoting Successful Birth Outcomes Numerous studies have shown links between the early initiation, amount, and content of prenatal care and birth outcomes. Outcomes that indicate problems in access include infant mortality, low birthweight, and incidence of congenital syphilis.
From page 6...
... , with its attendant transmission of sexually transmitted diseases. Rates of congenital syphilis therefore may also indicate a lack of available, acceptable, and effective drug treatment services for pregnant women.
From page 7...
... Access to immunization for childhood diseases provides the best current example of this potential of health care services. Figure 3 shows that less than half of nonwhite preschoolers in 1985 were immunized for measles and less than two-thirds of white preschoolers were so immunized.
From page 8...
... The committee focused on screening for breast and cervical cancer. Although public health education efforts are critical for creating awareness of screening tests, the personal
From page 9...
... women over the age of 18 had had a Pap smear in the previous three years to detect cervical cancer. Hispanic women are less likely to have had the procedure than black or white women.
From page 10...
... the percentages of women of that age reporting mammography who had incomes over $25,000 and under $25,000. The 1987 percentages are based on data from the National Health Interview Survey of that year; the 1990 percentages were calculated from data collected by the Mammography Attitudes and Usage Study conducted by the Jacobs Institute of Women's Health with technical assistance from the National Cancer Institute.
From page 11...
... That this is a problem worth monitoring emerges from the medical literature, which contains examples of medical and surgical procedures for which there are differences in utilization according to patient health insurance status, race, and other sociodemographic factors.
From page 12...
... Ongoing medical management can effectively control the severity and progression of a number of chronic diseases, even if the diseases themselves cannot be prevented. An advanced stage of a chronic disease requiring hospitalization may indicate the existence of one or more access barriers to personal health care services.
From page 13...
... High rates of admissions for conditions related to treatable chronic diseases, in particular, may provide indirect evidence of serious patient access problems or deficiencies in outpatient management (see Figure 7~. In comparisons of hospital admission rates for people from low- and high-income zip codes, all of the ambulatory-care-sensitive admission rates were substantially higher for low-income areas.
From page 14...
... A second utilization indicator moves from medical care to dental care, a set of services that have limited insurance coverage and thus the potential for being highly income sensitive. Dental services also represent an area of personal health care in which treatment, although usually not life saving, contributes to general well-being and social functioning.
From page 15...
... Consistent differences between whites and blacks persisted despite insurance coverage (Figure 8~. As income increases, the difference between the number of visits by those with insurance and those without decreases.
From page 16...
... The same organization should have the responsibility to provide technical assistance and consultation to local organizations that conduct their own analyses of access indicators. These efforts should include activities to encourage improved technical capacity and to promote, where appropriate, consistent definitions and analytic approaches.
From page 17...
... Understanding the potential payoffs, and the extent to which emerging national trends apply to local circumstances, will allow communities to determine their data collection needs. The committee recognizes that constrained state and local public health budgets are likely to limit investments in major new surveys, hospital discharge data collection systems, and cancer registries.
From page 18...
... This serviceintegration feature, generally acknowledged for prenatal care, is also present in a set of topics that the committee identified for further development as access indicators. These topics represent access problems that may be amenable to solutions requiring close linkages among personal health care services, public health, and social services.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.