Access to care

The Health Policy Institute of Ohio has recently adopted a three-year strategic plan that identifies four strategic objectives for informing health policy development in Ohio. One of those objectives is ensuring access to care for all Ohioans.

HPIO’s decision to focus on ensuring access to care for all Ohioans is based on several key factors:

• Uninsured Population. Access to health insurance remains a challenge for many Ohioans. The 2010 Ohio Family Health Survey estimates that about 1.4 million working age Ohioans and 125,000 children are uninsured and employer health surveys indicate that employer sponsored insurance continues to decline. According to Mathematica, “uninsured people generally receive much less care, either preventive or for acute and chronic conditions, than insured people.”
• Timeliness and Setting of Care.  Even for people who have insurance, access to timely care remains a concern. A  2008 Commonwealth Fund survey found that 73% of Americans reported "difficulty obtaining timely access to their doctor." Many individuals resort to receiving care at hospital emergency departments, despite evidence from a Rand Corporation study that more than 17% of all local emergency room visits are for conditions that can be treated in a less expensive setting.
• Primary Care Access.  Researchers from Johns Hopkins University found that access to primary care services leads to an increase in the provision of preventive services, immunization rates, and a decline in emergency department visits and inpatient hospitalizations. The Centers for Disease Control and Prevention estimates that 75% of U.S. health care spending is on chronic, preventable diseases, so increased primary care access can play an important role in reducing overall spending and promoting wellness.
• ACA Provisions.  Increasing access to health insurance, through Medicaid expansions, health insurance subsidies, the creation of a health insurance exchange, and the federal mandate requiring individuals to purchase minimum health care coverage, is the foundation of the Patient Protection and Affordable Care Act (ACA). However, according to the New England Journal of Medicine, states with large anticipated Medicaid expansions and less primary care capacity will likely face challenges meeting an increased demand for care. 
• Safety Net Capacity Limitations.  While free clinics and community health centers provide access to some care for the uninsured, capacity is limited and not all areas of the state, or even a specific community, are served. According to the Commonwealth Fund, patients in these settings, particularly those who are uninsured or covered by Medicaid, have greater difficulty accessing specialty care, including mental health, alcohol and drug addiction treatment and oral health services.  HPIO’s Safety Net Snapshot Project found similar access challenges in Ohio.
• Fair Access for All Ohioans. Some groups of Ohioans have less access to care than others.  Minority populations are more likely to be uninsured, according to the 2010 Ohio Family Health Survey; 27.6% of African Americans and 34% of Latino/Latinas lack health insurance, compared to 17% of whites. The 2010 National Healthcare Disparities Report from the Agency for Healthcare Research and Quality found themes that “emphasize the need to accelerate progress if the Nation is to achieve higher quality and more equitable health care in the near future,” such as:
  • Health care quality and access are suboptimal, especially for minority and low-income groups
  • Quality is improving; access and disparities are not improving
  • Urgent attention is warranted to ensure improvements in quality and progress on reducing disparities with respect to certain services, geographic areas, and populations

HPIO will inform health policy development related to access to care by working to:

• Analyze and educate policymakers
• Convene stakeholders around increasing access to care
• Foster the spread of access-related practices and programs that are producing promising results

Questions?

If you have questions about HPIO's health access work or would like more information,  please contact Mary Wachtel at 614.224.4950 x307 or mwachtel@hpio.net.