Access to Healthcare-Determinants of Access (exam 2) Flashcards
access to health services (definition)
timely use of personal health services to achieve the best health outcomes
access to health care (definition)
ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely fashion
criteria/determinants for/of access (6)
-availability
-affordability
-convenience
-acceptability
-effectiveness
-timeliness
access importance
-key determinant of health
-key measure of effectiveness of health care delivery
-access inequalities are important contributors to health disparities
-linked to quality of care
-access, navigation & effective utilization of health services have huge implication for population health and healthcare costs
how much do access to and use of health services contribute to health of individuals and society?
10%
comparing to 10 other industrialized countries does the US have a big problem with access to healthcare?
yes
Was the US found to be significantly different with respect to access, healthcare costs and affordability?
yes
factors for determining access to healthcare (4)
health system characteristics
individual characteristics
actual utilization of health services
outcomes of health services utilization
actual utilization of health services
objective measures of use
outcomes of health services utilization
measures patient satisfaction with the convenience, affordability, and acceptability of services
determinants of access: health system characteristics (3)
determined by Health Policies
-physical availability
-geographic distribution in relation to location of the individual
-organization of health care delivery
organization of health care delivery includes
how the patient enters the system,
navigates the system (eg referral system),
pays for the services provided
Determinants of Access: Individual Characteristics (3)
predisposing factors
enabling factors
perceived need
*according to the Andersen Behavioral Model of Healthcare Use
predisposing factors (definition)
demographic factors that may make the individual more or less likely to access or use available health services
predisposing factors include (5)
age
gender
marital status
educational level
health beliefs which may be culturally-related
enabling factors (definiton)
may facilitate the individuals’s access to and use of available health services
enabling factors include (4)
health insurance coverage
employment status
income
family & other support systems
perceived need (definition)
access and use of an individual depends on whether the individual believes that the services are actually needed and if they will be beneficial
Determinants of Access: Actual Utilization Measures (3)
- types of services used over a given period
- volume of services used by type
- frequency of services used by type, locality
volume of services used by type analyzed by (4)
population sub-groups
age group,
gender,
race/ethnicity,
insurance status
frequency of services used by type, locality analyzed by (4)
population sub-groups
age group,
gender,
race/ethnicity,
insurance status
Determinants of Access: Outcomes of Access Measured by Patient Satisfaction
patient-provider relationships
information/education provided and received
privacy/confidentiality of the care environment
overall quality of care received
patient satisfaction surveys
have become increasingly important
form an integral part of Patient-reported Health Outcomes (PRO)
required for health system and health plans accreditation
frequently used for marketing purposes
Patient-provider relationships (3)
cordial
respectful
inclusive in decision making
barriers to access to health services (6)
- cost of care (deductibles, copay for those insured)
- lack of coverage of selected services and/or providers by insures
- lack of insurance & hence usual source of care
- difficulty in navigating the system
- lack of coordination between services and/or providers
- patient’s perceived poor quality of care
difficulty in navigating the system due to
low health literacy and/or language barriers
patient’s perceived poor quality of care arising from
prejudice/stereotyping/discrimination on account of race/ethnicity, gender, sexual orientation
Access Disparities/Inequalities arise when
different sections of the population have differences in a access to needed services
Access Disparities/Inequalities (8)
- race/ethnicity
- socioeconomic status
- health insurance coverage
- gender
- culture or religious affiliation
- sexual orientation
- nature of illness
- geographic location
Implications of Access Disparities
- disparities in access are important since they contribute to health disparities
- Minorities and several under-served populations in the U.S. have higher burden of disease but poorer access to healthcare which together fuel health disparities
strategies for promoting access to healthcare: cost of care
Discounts enjoyed by using in-network providers & facilities
strategies for promoting access to healthcare: lack of insurance
Health insurance marketplace; provisions of the Affordable Care Act (ACA) including subsidies, expansion of Medicaid & CHIP etc
strategies for promoting access to healthcare: access navigation difficulties
Promoting health literacy & patient education; using interpreters to promote patient understanding and input into their own care
Strategies for Promoting Access to Care: Lack of coordination between services and/or providers
Use of case managers, patient navigators and coaches
Strategies for Promoting Access to Care: Perceived poor quality of care arising from prejudice/stereotyping/discrimination
- Promoting diversity among health workers to reflect the increasing population diversity
- Cultural competency training for healthcare providers
