Medicare-Certified Home Health Care: Urban-Rural Differences in Utilization

CONTEXT: Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail. PURPOSE: To examine urban-rural differences in Medicare HHC utilization. METHODS: The 2002 100% Medicare HHC claims and denominator files were used to estimate use of HHC and to make urban-rural comparisons on the basis of utilization levels within ZIP codes. FINDINGS: Overall, the proportion of Medicare beneficiaries living in areas with little HHC utilization is relatively low. Rural elders, however, are more likely than their urban counterparts to live in such areas. Less than 1% of urban beneficiaries live in ZIP codes with no or low use of HHC, but over 17% of the most rural beneficiaries live in such areas. CONCLUSIONS: Continued monitoring of rural HHC utilization and access is important, especially as Medicare seeks to evaluate the effectiveness of payment increases to rural home health agencies.     

Early Access to Health Care Services Through a Rural School-Based Health Center

ABSTRACT: School-based health centers (SBHCs) and school-linked health centers (SLHCs) represent relatively new models for health care service delivery. This article examines the question: Are SBHCs accessible as defined by four criteria of accessibility: available, community-based, affordable, and culturally acceptable? A literature review and an examination of a rural SBHC providing care to young children are presented in this paper. Both support the hypothesis that SBHCs are accessible to children and families in the school community. In particular, this SBHC's enrollment rate of 98% and its usage rate of 99% provide strong evidence that SBHCs are culturally acceptable. Ten strategies for a successful SBHC are presented to assist in planning and implementation of other SBHCs.     

吴仪:应人人享有基本卫生保健

2007年全国卫生工作会议在京召开期间,中共中央政治局委员、国务院副总理吴仪致信强调,要充分认识加快医疗卫生事业发展的重要性和紧迫性,努力解决群众看病难看病贵问题,为实现人人享有     

Traveling Towards Disease: Transportation Barriers to Health Care Access

Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.     

Health Care Needs of the Growing Latino Population in Rural America: Focus Group Findings in One Midwestern State

Latinos represent nearly 13% of the U.S. population, surpassing African-Americans as the nation's largest racial/ethnic group. Many rural midwestern communities are seeing unprecedented growth in their Latino populations, creating new challenges and pressures for health and social service providers. This study is based on four focus groups conducted in three rural communities to examine concerns with health care services and access to care. Focus group analysis found several key barriers to health care access, including cost of health care services and frustration with the complexity of the U.S. health care system, as well as language and cultural issues that adversely affect patient-provider relationships. In addition, a number of impediments related to employer-sponsored health coverage were identified, including prohibitive premium costs as well as concerns about occupational injuries and access to care during work hours. The growth of the Latino population in the rural Midwest will require changes in existing health and social service systems to serve as a bridge to new systems in this country. We recommend several policy options including premium subsidies for low-wage jobs, community-based enrollment specialists for public programs, and continued research and data collection to monitor change and progress.     

Access to Transportation and Health Care Utilization in a Rural Region

CONTEXT: Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. PURPOSE: This analysis addresses the association of transportation and health care utilization in a rural region. METHODS: Using survey data from a sample of 1,059 households located in 12 western North Carolina counties, this analysis tests the relationship of different transportation measures to health care utilization while adjusting for the effects of personal characteristics, health characteristics, and distance. FINDINGS: Those who had a driver's license had 2.29 times more health care visits for chronic care and 1.92 times more visits for regular checkup care than those who did not. Respondents who had family or friends who could provide transportation had 1.58 times more visits for chronic care than those who did not. While not significant in the multivariate analysis, the small number who used public transportation had 4 more chronic care visits per year than those who did not. Age and lower health status were also associated with increased health care visits. The transportation variables that were significantly associated with health care visits suggest that the underlying conceptual frameworks, the Health Behavior Model and Hagerstrand's time geography, are useful for understanding transportation behavior. CONCLUSIONS: Further research must address the transportation behavior related to health care and the factors that influence this behavior. This information will inform policy alternatives to address geographic barriers to health care in rural communities.     

Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA) offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.     

Children with Special Health Care Needs: How Immigrant Status is Related to Health Care Access,Health Care Utilization,and Health Status

To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0–11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent’s language, parental education, ethnicity, and children’s insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.     

Access to Health Care in the Scandinavian Countries: Ethical Aspects

The health care systems are fairly similar in theScandinavian countries. The exact details vary, but inall three countries the system is almost exclusivelypublicly funded through taxation, and most (or all)hospitals are also publicly owned and managed. Thecountries also have a fairly strong primary caresector (even though it varies between the countries),with family physicians to various degrees acting asgatekeepers to specialist services. In Denmark most ofthe GP services are free. For the patient in Norwayand Sweden there are out-of-pocket co-payments for GPconsultations, with upper limits, but consultations forchildren are free. Hospital treatment is free inDenmark while the other countries use a system without-of-pocket co-payment. There is a very strongpublic commitment to access to high quality healthcare for all. Solidarity and equality form theideological basis for the Scandinavian welfare state.Means testing, for instance, has been widely rejectedin the Scandinavian countries on the grounds thatpublic services should not stigmatise any particulargroup. Solidarity also means devoting specialconsideration to the needs of those who have lesschance than others of making their voices heard orexercising their rights. Issues of limited access arenow, however, challenging the thinking about a healthcare system based on solidarity.     

Low-Income Uninsured Patient Health and Access to Health Care through a Community Health Program in NC

Project Access provides free primary and specialty care for low-income uninsured residents of Buncombe County, NC through a physician volunteer network. In 2010, we replicated a 1998 study investigating health issues among Project Access (PA) patients. Over 300 patients enrolled in PA in 2009 were surveyed by telephone. Currently, as compared to 1998, fewer patients were employed (31% vs. 44.2%, p < 0.05), more patients were unable to return to work (15.6% vs. 8%, p < 0.05), and patients were enrolled in PA for longer (24.5 months vs. 14 months). The SF-12 Physical Health score was worse in 2010 (p < 0.05). With the implementation of Health Reform, certain groups of people will still require PA services, but a significant portion will be covered by Medicaid; with our PA patients reporting poorer health status, Medicaid resources may be strained even more than anticipated.