More coverage, better care: improving children's access to health services

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of grantmakers and health services researchers on November 4, 2005 for an informative discussion about improving children's access to health services, including the opportunities, challenges, and roles for funders. This Issue Dialogue, entitled More Coverage, Better Care: Improving Children's Access to Health Services, covered how the current health care system succeeds and fails for children, emerging policy developments, and what grantmakers are currently doing to promote children's access to health services. The meeting also explored the lessons learned by grantmakers to help guide future work.     

GP Clinic: promoting access to primary health care for mental health service clients

Objective: To evaluate an innovative rural service offering comprehensive primary health care for mental health service clients. Design: A formative evaluation using mixed methods. Setting: A rural NSW community. Participants: Fifteen health care providers and 120 adult clients. Intervention: A monthly clinic held in a general practice to provide primary health care for clients of the community mental health team. Main outcome measures: Client utilisation and clinic activity data. Provider views of service effectiveness, possible improvements and sustainability. Results: The GP Clinic has operated successfully for 2.5 years without access block. Some 52% of clients had no physical illness and 82% were referred to other health and community services. In total, 40% continued to attend the clinic while 32% went on to consult a GP independently. Client access to care improved as did collaboration between the community mental health team and primary care providers. Conclusion: The GP Clinic is a straightforward and flexible service model that could be used more widely.     

医疗服务需求管理是解决“看病难、看病贵”的关键路径

对如何解决＂看病难、看病贵＂的问题,目前政策切入点主要是增加投入,加强基层卫生服务能力建设,扩大医疗服务机构规模和医疗保险覆盖范围,而对医疗服务需求管理尚缺乏足够的重视。     

卫生服务可及性评价

该主要介绍了卫生服务利用行为模型,列举了卫生服务可及性的分类和指标,旨在对卫生服务可及性的基本理论作一介绍,并探讨卫生服务的可及性评价对我国卫生改革的意义。     

The Promise Clinic: a service learning approach to increasing access to health care

The goal of the Promise Clinic (a project of an academic medical center and a local social services group) is to increase access to primary care for an underserved population while addressing deficiencies in medical education. Students manage common primary care problems, creating access for this mostly uninsured population.     

HRSA's Models That Work Program: implications for improving access to primary health care.

The main objective of the Models That Work Campaign (MTW) is improving access to health care for vulnerable and underserved populations. A collaboration between the Bureau of Primary Health Care (BPHC) at the Health Resources and Services Administration (HRSA) and 39 cosponsors--among them national associations, state and federal agencies, community-based organizations, foundations, and businesses--this initiative gives recognition and visibility to innovative and effective service delivery models. Models are selected based on a set of criteria that includes delivery of high quality primary care services, community participation, integration of health and social services, quantifiable outcomes, and replicability. Winners of the competition are showcased nationally and hired to provide training to other communities, to document and publish their strategies, and to provide onsite technical assistance on request.     

Reduced low birth weight for teenagers receiving prenatal care at a school-based health center: effect of access and comprehensive care.

PURPOSE: To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenagers receiving prenatal care in comprehensive adolescent pregnancy programs (CAPPS) in two different settings: school-based vs. hospital-based. METHODS: Retrospective sohort study using existing data sources: medical records and birth certificates. Using school rosters and hospital clinic databases, we identified pregnant adolescents < or =18 years old who delivered a baby between July 1, 1995 and August 30, 1997 and who received prenatal care in a school-based CAPP (SB-CAPP) or hospital-based CAPP (HB-CAPP). Process of care measures (prenatal care adequacy and comprehensive care) and outcomes (low birth weight) were examined by site of care. Logistic regression models were computed to predict the odds of low birth weight by site of prenatal care, adjusting for prenatal care adequacy, comprehensive care, and possible confounders including baseline maternal characteristics. RESULTS: Three-hundred-ninety eligible teens were identified. Mean age was 15.9 years, 93% were African-American, 84% in school, 13% had a prior birth, and 11% were cigarette smokers. Teens receiving care in the SB-CAPP were significantly younger and more likely to be in school than those in the HB-CAPP. Overall, the two groups had similar low rates of prenatal care adequacy, but compared with teens in the SB-CAPP, those in the HB-CAPP were 1.5 times less likely to receive comprehensive care. Logistic regression analyses adjusting for baseline maternal differences showed that HB-CAPP teens were more than three times as likely to deliver a low birth weight infant compared with SB-CAPP teens (AOR 3.75; 95% CI 1.05-13.36). The increased odds of low birth weight for HB-CAPP teens attenuated when prenatal care was adequate and comprehensive (AOR-HB-CAPP: 2.31, 95% CI 0.65-8.24). CONCLUSIONS: School-based prenatal care was associated with significantly lower odds of low birth weight compared with HB-CAPP care. Although selection bias may be a factor in this observational study, our findings suggest that these improved birth outcomes may be mediated through prenatal care adequacy and provision of comprehensive care.     

A community expands access to health care: the case of access health in Michigan

Access Health, a Michigan-based "three-share plan," is viewed as a successful community-based approach to expanding health benefits in the workplace. It was the stimulus for recently proposed legislation to federally fund similar plans nationally. The program evolved with the support of the W.K. Kellogg Foundation. Its sustained viability is attributable in part to the creative use of a state statute to draw down federal Medicaid disproportionate-share hospital (DSH) funds. Although it faces obstacles common to programs of its type, the program's greatest financial vulnerability rests on the uncertain continued availability of the monies it uses to subsidize the program.     

Insurance + access not equal to health care: typology of barriers to health care access for low-income families

PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.