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Access to Care

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Ashley Barnhouse

on 6 November 2016

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Transcript of Access to Care

Tiffani Taylor, Karen Aroche, Hunter Worrell, Hope Strothers, Rachel Bader, Alexis Taylor, Ashley Barnhouse, Katherine Perez-Montenegro , Corene Cantwell

Access to Care
Results of the Study:
Coverage gaps = increased likelihood of unmet needs

Continuous Insurance Coverage - Private and public health insurance may give equal coverage

We are the only first world country that does not have a universalized healthcare system.
purpose of the Affordable Care Act is to provide insurance for the general population.

Affordable Care Act (ACA)
Health Insurance
Population Health
Promotion of Health
Prevention of Disease

Access to Care
What is Access to Care?
“The ease with which an individual can obtain medical services.”

It is imperative to prevent disparities in the healthcare system.
It is necessary in order to ensure a patient’s quality of care.
Positively impacts job opportunities for nurses by increasing the demands for patient care and advocacy

Why is this important and relevant to health care?
ANA's Position Statement

PROFESSIONAL NURSING is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA, 2015).

President Obama signs the Affordable Care Act in action; Patient Bill of Rights is created.
Accountable Care Organizations were created.
Free preventative services were made available to uninsured Americans.
Open enrollment began on October 1st.
All Americans have access to affordable health insurance options.
Capitalism of Healthcare
Over the last 20-30 years healthcare has shifted to being all about making a profit.

Patients are looked at as “good business” or “bad business.”

This leads to a decrease in the availability of healthcare.
“Healthcare is a multi-billion dollar business” -The Huffington Post
Hospitals and clinics were once charitable organizations that cared for the health and well-being of its patients.
Facts Concerning Health Insurance in the US
(Victor R. Fuchs, PhD)
Facts Concerning Health Insurance in the US

Private Health Insurance
Pros: Ability to tailor health care coverage to fit specific needs
Cons: Expensive

Public Health Insurance
Pros: Less costly to consumer (less out-of-pocket expenses)
Cons: Meeting eligibility requirements- pre-existing conditions, etc. (may limit access to medical care)

“Access to health insurance influences the amount and quality of health care received, which in turn is likely to be related to survival.” - McDavid K. Tucker TC
(Tucker et al., 2003, pg. 1)
The United States is the
first-world country that does not possess a
universalized healthcare system.
(Fisher, 2012)
Facts Concerning Health Insurance in the US
Health Insurance
“Comparing Types of Health Insurance for Children: A Public Option Versus a Private Option”

Conducted by: Jennifer E. DeVoe, MD, Dphil & colleagues
Department of Family Medicine, Portland OR

Data gathered from MEPS – Medical Expenditure Panel Survey

Population studied: Children of low to middle income families’ access to care.
• All/partial year public insurance
• All/partial year private insurance
• Uninsured

Health Insurance
(Devoe, et al., 2011)
ACA: Affordable Care Act
ACA: Affordable Care Act (ACA)
Full name: “Patient Protection and Affordable Care Act”

Also referred to as “Obamacare”

Established in 2010 under the Obama administration

Promotes prevention and access to free medical care

The Affordable Care Act's (ACA) Effects on the Healthcare Environment
Made healthcare more accessible to many Americans (19-26 year old young adults)
Section 2714 of the ACA targets the issue of coverage among young adults. The provision allows holders of private family plans to add children under the age of 26 to the policy, regardless of the child’s circumstance.

Patients are now seeking treatment for their conditions

There has been a
decline of people claiming a delay in treatment due to the cost.

After Medicaid Expansion - Massachusetts saw a decrease in mortality rates.

The ACA's Impact on the Nursing Profession
Expanding availability of jobs in nursing
APRN- Advanced Practice Registered Nurses
Nurse Managers
CNS- Clinical Nurse Specialist
Increased demand for Nurse Practitioners

There is also a shift in nurses from hospitals to home health care.
***affects how Nurses tackle health promotion and disease prevention.

Institute of Medicine (IOM)- “The Future of Nursing”
Baccalaureate Degrees

Emergency Services
Patients visiting emergency department for non-emergency medical care.

(Finkelman and Kenner 164-165)
What are the health care needs of the larger population of this country?
General Population Health
Compared to other OECD countries:
The annual US healthcare expenditures are
as high as other countries

Top 5 Leading Causes of Death in the US population
(1) Heart disease: 614,348
(2) Cancer: 591,699
(3) Chronic lower respiratory diseases: 147,101
(4) Accidents (unintentional injuries): 136,053
(5) Stroke (cerebrovascular diseases): 133,103

The needs of the larger populations need to be addressed by implementing regulations/services in order to decrease healthcare disparity.
(Leading Causes of Death, 2016)
Populations With Limited Access to Care
Low socioeconomic status (SES)
Limited education
LGBTQIA individuals
Individuals with mental/physical disabilities
Language/different cultural backgrounds
Transgender Health
Transgender individuals lack access to culturally competent health care workers

Lack of education about trans health among health care providers

The US Department of Health and Human Service (HHS) Office for Civil Rights has begun to investigate complaints that health-care providers have violated the section of the ACA that prohibits discrimination by their mistreatment of transgender patients.

Health care insurance companies sometimes reject their claims for screening or treatments, even though the ACA prohibits insurance companies from denying coverage based on gender or health history.

We as nurses need to modernize systems to accommodate LGBTQIA individuals.
About 28% of respondents said they postponed medical care when they were sick or injured because of discrimination. 19% overall reported having been refused care because they were trans, and 28% said they were subjected to harassment in medical settings.

50% of the participants in the survey reported having to teach their medical staff about appropriate trans care.

Study done in 2011 by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. It had 6456 respondents from all 50 states
Limited access to care leads to health care disparities.
(O’Hara et al., 2013, 1581-1592)
Prevention of Disease
Affordable Care Act 2010
Title IV addresses the Prevention of Chronic Diseases and Improving Public Health by:
Providing people with improved access to clinical preventative services by removing cost as a barrier to these services
-Examples: immunizations and screening for various forms of cancer (breast, cervical, colorectal)

The law promotes wellness in the workplace by supplying health promotion opportunities for employers and employees
-Example: assisting in implementation of wellness programs in the workplace by funding grants for small businesses
(Koh & Sebelius, 2010)

Stresses the role of communities in promoting prevention
- Example: community transformation grants promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness
* These grants prioritize strategies to reduce healthcare disparities!!

Holds prevention of disease as a national priority so Title IV focuses on promoting health through all policies
- Example: The National Prevention, Health Promotion, and Public Health Council, create a prevention and health promotion strategy for the country.
(Koh & Sebelius, 2010)
Affordable care Act promotes disease prevention through decreasing and removing costs from immunizations
Affordable Care Act requires first dollar coverage for ACIP (Advisory Committee for Immunization Practices) recommended vaccinations.
“First dollar coverage” refers to removing the copays and deductibles for vaccinations that are recommended by the ACIP
Vaccination rates increase due to the “first dollar coverage”

CHIP (Children’s Health Insurance Program) requires coverage of age applicable immunizations for children.
Kids who are covered by CHIP are more likely to be up to date with their immunizations, they have more check ups, and have fewer emergency visits

In the past, healthcare providers have placed a focus on spending excessive amounts of money to cure diseases instead of financially supporting disease prevention and promotion of health.
Nursing Research and Prevention of Disease
National Institute of Nursing Research (NINR) greatly focuses on supporting research on cost-effective measures that target health disparities and vulnerable populations.

“Being a vital part of the health care delivery system, nurses have the responsibility to not only provide direct care to individuals affected by these diseases, but also to address risk factors that may be present at the population level. By studying population-based characteristics and developing, implementing, and evaluating interventions that target infectious diseases among vulnerable populations, nursing has begun to address this issue.”

( Peragallo & Gonzales, 2007)
Current Health Concerns
There are many epidemics happening across the world as we speak. A few current ones would include the cholera outbreak in Haiti, Zika virus, and Obesity. The CDC has stressed prevention strategies for Heart disease, Sexually Transmitted Diseases (STD’s), and the Influenza.

Promotion of Health
Triple Aim
Through Triple Aim the Institute for Healthcare Improvement’s (IHI’s) has pursued these three concepts:
Enhancing patients’ quality of care
Reducing cost of care
Promoting health

There are other services in place that promote health such as: prevention and wellness programs, incentives for Nondiscriminatory Wellness Programs, and Health-contingent Programs.

(The IHI Triple Aim, 2012)
“There is hope that with the healthcare reform of 2010, there will be a greater opportunity to develop a more coordinated healthcare system that includes public/community health delivery, although the Affordable Care Act focuses primarily on healthcare reimbursement” (Finkelman A., Kenner C., p. 203).
The cost of a hospitalized, malnourished patient can be up to
2 to 3 times higher
than that of a well nourished patient.
Proper Nutrition

ACA's Response
Title IV: Prevention of Chronic Disease and Improving Public Health
Certain restaurants and vending machines must post calorie info
Science-based info and tools will be given to healthcare providers in efforts to produce preventative and obesity-related services

Increased need for healthcare professionals that offer nutrition services (ie, dieticians and nutritionists)
(Title V. Health Care Workforce)
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Program that provides:
Nutrition education
Growth monitoring
Breastfeeding promotion and support (Prenatal care)
Food to low-income pregnant or postpartum women, infants, and children (Under age 5)
Household income less than 185% of federal poverty level ($37,000)
Or Enrollment in another program with similar income requirements
***Ex: Medicaid

Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps
Program that provides:
Nutrition assistance to low-income individuals and households
State agencies, nutrition educators, and neighborhood/faith-based organizations are involved
Low income (based on household size and gross (130% of poverty) and net (100% of poverty) monthly income
Must be actively job searching
Not quitting or asking for less hours at job
Accept job offer
Participation in employment training programs assigned by the state
(Supplemental Nutrition Assistance Program (SNAP), 2016)

Revisions are Needed
Receiving public food assistance was positively associated with fair/poor health status and food insecurity (from a health center-based study published by Johns Hopkins University Press)
Needs stricter regulations and systematic approach to effectively address these issues

Robert Wood John Foundation’s Commission to Build a Healthier America
Founder: Robert Wood “General” Johnson II
Largest philanthropy exclusively concerned with health
Wants to introduce full-service grocery stores in food deserts (which may decrease likelihood of cycle of sickness)
(Our Founder - Robert Wood Johnson Foundation)

Prenatal Care

four million

live births are delivered to women each year in the US.”
-Greg R. Alexander & Milton Kotelchuck
Prenatal Care: Under ACA
Type of preventative health care a woman receives from a professional
(Ex: Obstetrician, Midwife)
Regular check ups with a doctor
Discuss medical history, physical exams, information on pregnancy
Prenatal testing
Common tests include: Ultrasound, Multiple Marker Screening, Chorionic Villus Sampling (CVS), Biophysical Profile (BPP)
Check for complications in pregnancy
Assesses health of both mother and fetus
Blood and Urine Tests

Reduces risks of low birth rate in infants
May prevent fetal abnormalities
Reduce risk of pregnancy complications
Ensure health of mother and fetus through nutritional tips and knowledge on pregnancy

The Bottom Line
(1) We have moved away from treatment and are shifting towards preventative care.
Nurses have a huge impact on promoting population-based interventions

(2) Emphasis on access to care positively impacts job opportunities for nurses by increasing the demands for patient care and advocacy.

(3) The
ultimate goal
is to reduce healthcare disparities among the larger population. (ACA)

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