Access to health care in America / / Committee on Monitoring Access to Personal Health Care Services, Institute of Medicine ; Michael Millman, editor

• Record Nr.: UNINA9910960091603321
• Pubbl/distr/stampa: Washington, D.C., : National Academy Press, 1993
• ISBN: 9786610211562; 9781280211560; 1280211563; 9780309584661; 0309584663; 9780585025452; 0585025452
• Edizione: [1st ed.]
• Descrizione fisica: x, 229 p. : ill
• Altri autori (Persone): MillmanMichael L
• Disciplina: 362.1/0973
• Soggetti: Health services accessibility - United States - Evaluation; Medical care - United States
• Lingua di pubblicazione: Inglese
• Formato: Materiale a stampa
• Livello bibliografico: Monografia
• Note generali: Bibliographic Level Mode of Issuance: Monograph
• Nota di bibliografia: Includes bibliographical references and index.
• Nota di contenuto: Access to Health Care in America -- Copyright -- Contents -- Summary -- GENERAL CONCLUSIONS ON THE STATE OF ACCESS -- DEFINING ACCESS -- THE COMMITTEE'S INDICATORS AND PROGRESS TOWARD ACCESS OBJECTIVES -- Objective 1: Promoting Successful Birth Outcomes -- Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases -- Objective 3: Early Detection and Diagnosis of Treatable Diseases -- Objective 4: Reducing the Effects of Chronic Disease and Prolonging Life -- Objective 5: Reducing Morbidity and Pain through Timely and Appropriate Treatment -- RECOMMENDATIONS -- 1 Introduction -- BACKGROUND -- DEVELOPING A SET OF INDICATORS -- RELATIONSHIP OF ACCESS MONITORING TO OTHER RELEVANT ACTIVITIES -- MAJOR DATA SOURCES: THEIR USES AND LIMITATIONS -- Strengths and Weaknesses -- Vital Statistics -- Surveys -- Hospital Discharge Data -- Tumor Registries -- Reportable Diseases -- Claims Data -- CROSSCUTTING ; ISSUES -- Race/Ethnicity -- Timeliness -- REFERENCES -- 2 A Model for Monitoring Access -- DEFINING ACCESS -- MEASURING ACCESS -- Indicators -- Utilization Indicators -- Outcome Indicators -- Utilization and Its Relationship to Health Care -- Mediating Factors -- Barriers to Access -- Structural Barriers -- Financial Barriers -- Personal and Cultural Barriers -- The Relationship of Access Barriers to Indicators -- REFERENCES -- 3 Using Indicators to Monitor National Objectives for Health Care -- OBJECTIVE 1: PROMOTING SUCCESSFUL BIRTH OUTCOMES -- Utilization Indicator: Adequacy of Prenatal Care -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Infant Mortality -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Low Birthweight -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Congenital Syphilis -- Measuring the Indicator.; Trends in the Data -- Recommendations -- OBJECTIVE 2: REDUCING THE INCIDENCE OF VACCINE-PREVENTABLE CHILDHOOD DISEASES -- Utilization Indicator: Preschool Immunization -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Incidence of Vaccine-Preventable Childhood Diseases -- Measuring the Indicator -- Trends in the Data -- Recommendations -- OBJECTIVE 3: EARLY DETECTION AND DIAGNOSIS OF TREATABLE DISEASES -- Utilization Indicators: Breast and Cervical Cancer Screening Procedures -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Incidence of Late-Stage Breast and Cervical Cancers -- Measuring the Indicator -- Trends in the Data -- Recommendations -- OBJECTIVE 4: REDUCING THE EFFECTS OF CHRONIC DISEASES AND PROLONGING LIFE -- Utilization Indicator: Continuing Care for Chronic Diseases -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Utilization Indicator: Use of High-Cost Discretionary Care -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Avoidable Hospitalization for Chronic Diseases -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Access-Related Excess Mortality -- Measuring the Indicator -- Trends in the Data -- Recommendations -- OBJECTIVE 5: REDUCING MORBIDITY AND PAIN THROUGH TIMELY AND APPROPRIATE TREATMENT -- Utilization Indicator: Percentage of Healthy Individuals Who Do Not Contact a Physician During an Acute Episode of Illness -- Measuring the Indicator -- Trends in the Data -- Recommendation -- Utilization Indicator: Dental Services -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Avoidable Hospitalization for Acute Conditions -- Measuring the Indicator -- Trends in the Data -- Recommendation -- REFERENCES.; 4 Future Indicators -- ACCESS TO HEALTH CARE FOR PEOPLE WITH DISABILITIES -- FAMILY VIOLENCE -- EMERGENCY SERVICES -- POST-ACUTE-CARE SERVICES FOR THE ELDERLY -- PRESCRIPTION DRUGS -- REFERENCES -- 5 Recommendations -- RECOMMENDATIONS -- Crosscutting Recommendations -- State and Local Monitoring -- The Federal Role -- Racial and Ethnic Differences -- FUTURE STEPS -- Objective 1: Promoting Successful Births -- Indicator: Prenatal Care -- Indicator: Infant Mortality -- Indicator: Low Birthweight -- Indicator: Congenital Syphilis -- Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases -- Indicator: Preschool Immunization -- Indicator: Incidence of Vaccine-Preventable Childhood Diseases -- Objective 3: Early Detection and Diagnosis of Treatable Diseases -- Indicator: Breast and Cervical Cancer Screening Procedures -- Indicator: Incidence of Late-Stage Breast and Cervical Cancers -- Objective 4: ; Reducing the Effects of Chronic Diseases and Prolonging Life -- Indicator: Continuing Care for Chronic Diseases -- Indicator: High-Cost Discretionary Care -- Indicator: Avoidable Hospitalization for Chronic Diseases -- Indicator: Access-Related Excess Mortality -- Objective 5: Reducing Morbidity and Pain through Timely and Appropriate Treatment -- Indicator: Acute Medical Care -- Indicator: Dental Services -- Indicator: Avoidable Hospitalization for Acute Conditions -- REFERENCE -- APPENDIXES -- A Developing Indicators of Access to Care: The Case for HIV Disease -- ROBERT WOOD JOHNSON FOUNDATION AIDS HEALTH SERVICES PROGRAM AND EVALUATION -- ISSUES IN ASSESSING ACCESS TO PERSONAL HEALTH CARE -- Financial Barriers -- Insurance Coverage -- Provider Reimbursement Rates -- Investment in Resources for Treating HIV Disease -- Structural Barriers -- Lack of a Primary Source of Care -- Lack of Appropriate Service Providers.; Distance from care Providers -- Extended Waiting Times for Providers -- Personal Barriers -- Attitudinal Barriers -- VIABILITY OF DEVELOPING ACCESS INDICATORS FROM EXISTING DATA SETS -- Decreased Mortality Using Case-Finding -- Reduced Mortality Using Medical Management -- Reduced Morbidity and Improved Function -- CONCLUSION -- REFERENCES -- B Developing Indicators of Access to Care: Waiting Lists for Drug Abuse Treatment -- METHODS -- THE NUMBER OF PERSONS ON WAITING LISTS -- ''THERE ARE NO REAL WAITING LISTS FOR TREATMENT -- WAITING LISTS UNDERESTIMATE UNMET DEMAND -- SHOULD THERE BE WAITING LISTS? -- EMPIRICAL STUDIES OF WAITING LIST BEHAVIOR -- DISCUSSION -- FINAL COMMENT -- REFERENCES -- C Developing Indicators of Access to Care: The Case for Migrants and the Homeless -- MIGRANT HEALTH STATUS -- HEALTH STATUS OF THE HOMELESS -- RECOMMENDATIONS -- REFERENCES -- D "Ambulatory-Care-Sensitive" Conditions and "Referral-Sensitive" Surgeries -- Index.
• Sommario/riassunto: Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators. This useful volume defines a set of national objectives and identifies indicators--measures of utilization and outcome--that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location. The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring. This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.