Flashcards in 2. Access to Care Deck (52)
2 major components for access to health care?
Ability to pay, availability of health care personnel/facilities that are accessible, culturally acceptable, and capable of providing timely, appropriate care
Trend for health insurance coverage from 1930-2009?
1930s-1970s saw more insured people cuz of the growth of private health insurance and 1965 Medicare/Medicaid passage. Since 1980, number increased to twice as much cuz of decreasing private insurance coverage.
Accountable Care Act is supposed to do what to uninsured rates?
Drop in half from around 50 million
Why has private health insurance coverage decreased over the past decades? (3)
1) Skyrocketing cost of health insurance has made coverage unaffordable for many business, either drop insurance or shift cost of premiums/services onto employees. 2) Economy has shifted from high pay/unionized/full time to low pay/non-unionized/part time (less likely to be provided insurance) 3) Link of private insurance with employment means coverage interruption (unstable nature of employment)
How has the erosion of private insurance coverage been countervailed?
Through major expansion of public insurance coverage through Medicaid and State Children's Health Insurance Program (SCHIP)
How is the transient nature of employment linked insurance compounded?
Difficulties in maintaining eligibility for Medicaid (a small increase in income can rule out qualification)
Ethnicity of uninsured?
12% white, around 20% are black Asian, a third are Latino
Uninsured can be divided into what 2 major categories?
Employed uninsured (75%, includes children/spouse of working person) and unemployed uninsured (and ineligible for Medicaid)
Is insurance really necessary?
People lacking insurance receive less care and have worse health outcomes (increase risk of dying by 25%, accounts for 18k deaths/year in US)
If you have Medicaid, how good is your access to care?
By no means guaranteed - Medicaid pays docs far less than MCARE/Private insurance, docs don't accept. Having MCAID is like intermediate access between those with private and those without insurance
What is underinsurance?
Health insurance coverage has limitations that restrict access to needed services (like, a fifth of insured Americans)
4 phases of underinsurance?
Limits to insurance coverage, high deductibles/copayments, gaps in MCARE coverage, and lack of coverage for long-term care
On average, what percentage does Medicare pay for the health care expenses? And what's the deal with MCARE Part D?
About half. MCARE Part D requires beneficiaries to continue shouldering large out-of-pocket expenses for their meds.
Do elderly in nursing homes qualify for MCAID?
Only when they're buckass poor...gotta use up all your life savings then get qualified.
Nonfinancial barriers to health care? (5)
Lack of prompt access, gender, race, relation between health status and health care, health status and income
Explain lack of prompt access.
Growing shortage of PCPs, and less are accepting MCAID...inappropriate ED visits.
Explain gender and access.
With MALE MDs, Women are more likely to be satisfied with care, are prescribed fewer diagnostic tests, are less likely to be counseled about prevention stuff, are more likely to have MCAID (docs turn them away), and have limited access to abortions.
Explain race and access.
Higher proportion of minorities is uninsured/MCAID/poor, so they have health access problems. Studies have shown that blacks and Latinos receive fewer services even when compared to white people with same level insurance/income level.
Why can explain disparities in access to care across racial groups that aren't accounted for by socioeconomic status? (3)
1) cultural differences about value of medical care 2) ineffective communication (but sometimes even that doesn't account for disparity) 3) YOU JUST RACIST, BITCH
Explain relation between health care and health status.
Access to health care doesn't itself guarantee good health - environment and life decisions factor in. EG of the coal miner who had excellent insurance but died of pneumonia/black lung disease.
Explain health status and income.
IN GENERAL, lower income people are less likely to be healthy. Also, mortality rates are higher in states that have more unequal distribution of income.
Black, Latino, Native American, and Asian mortality rates?
Black and Native American have higher mortality rates than whites, and Latinos and Asians have lower rates.
Why doe Latinos have lower mortality rates?
Many Latinos are immigrants, and foreign-born people often have lower mortality rates than people born in the US at the same level of income. (Health Immigrant Effect)
Problems for MD offices if they accept MCAID pts?
1) Too many MCAID pts, very little compensation, means can't afford expenses to keep the office running and malpractice insurance 2) Fear of being sued by MCAID pts cuz they're at high risk for stuff
Who burdens the cost of MCAID? Who qualifies?
States, federal govt. Kids, pregnant women, disabled adults, and nursing home residents.
Who is responsible for controlling spending?
STATE - sets limits on eligibility, benefits, and provider payments (broad federal guidelines)
2 big outcomes of the new health care law?
In 2014, 1) Millions will be eligible for assistance with coverage 2) Insurance companies will no longer be able to deny coverage or charge higher premiums to people with pre-existing conditions
How many people between 25-64 years die prematurely (in 2010) due to lack of health coverage in the US?
26k. Mostly CA, TX, FL, NY, and GA
Which states substantially expanded MCAID eligibility in 2000? Results? (4)
NY, ME, and AZ. Reduced mortality, improved coverage, access to care, and self-reported health