What are some individual level barries to healthcare access?
- Race and ethnicity
- Socioeconomic status
What are some contextual level barriers to helath care?
Area level socioeconomic status (SES)
- The average socioeconomic status of the neighborhood
o Provider characteristics (does the area attract highly qualified phsycians?)
o Health system level factors (presence of level 1 trauma center vs. community hospital)
o Geographic residency status (rural, suburban, urban)
What are some poor outcomes in minority racial/ethnic groups that are not a result of access?
minority populations have worse outcomes in the following morbidities:
- cardiovascular care, cancer care, HIV care, diabetes care, end-stage renal disease and kidney transplantation, pediatric care and maternal and child health, mental health, rehabilitative and nursing home services, and many surgical procedures
- all of these worse outcomes occur controling for access
- minorities are more likely to receive more invasive procedures like mastectomy instead of breast conserving surgery
Define healthcare acess
the timely use of affordable health services to achieve the best possible health outcomes
What are some pt level barriers to quality care?
- Demographics (age, gender, insurance, social class, race, ethnicity, and geography)
- Language and acculturation
- Distrust of health profession
- Lower levels of health literacy
- Family and cultural contexts
What are some provider level barriers to quality care?
- Characteristics (gender, age, race, specialty practice, and years since graduation)
- Biases and beliefs about screening and treatment efficacy
- Deficient knowledge and training
- Lack of culturally sensitive resources
- Lack of time and forgetfulness
- Concerns about patient acceptance
- Lack of reimbursement or cost concerns
- Logistic or organizational barriers
What are some healthcare system level barriers to quality care?
- Organizational and structural factors (hospital type and size, teaching status, and availability of services)
- Structure and process of primary and specialty care
- Reimbursement and financial forces (ex. Closings and relocations)
- Neighborhood health care resources (rural vs. urban, and regional variations)
What are some ways policy can be used to improve healthcare eqality?
o Equalizing access to high-quality health plans
o Medicare should strive to help beneficiaries access the same health products as privately-insured patients
What can healthcare systems do to reduce healthcare inequality?
- Interpretation services
- Employ community health workers
- Educate providers about community needs and the culture of the community
- Help to increase access to preventive and primary care services
- promote the use of multidisciplinary teams, including physicians, nurses, dietitians, and social workers improve healthcare outcomes
What can pts do to lower healthcare inequality?
Pts should seek education and self advocate for better care to improve their own health outcomes
What is a pt navigator?
Define primary, secondary and teritary care and explain how navigators help pts access these resources?
Navigator - works with pts to identify and remove barriers to care and access support systems
- Individual helps pts access primary, secondary and tertiary care
o Primary care – physician encounter (immunizations ets..)
o Secondary care – diet/exercise/community resources
o Tertiary care – physical therapy and psychotherapy to reduce disability