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02.03 Access to Care

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Overview

We will discuss how barriers to care can directly impact community health goals.

Nursing Points

General

  1. Access to care
    1. Use of health service
      1. Ability to locate/pay/receive
      2. Goal
        1. Wellness
        2. Best outcomes
    2. Services
      1. Availability
      2. Primary care source
    3. Coverage
      1. Insured vs. Uninsured
    4. Timeliness
      1. Receiving care when needed
    5. Workforce
      1. Available  providers
        1. Culturally competent
        2. Person-centered
  2. Oversight
    1. Local/State government
      1. Monitoring
      2. Disease control
      3. Regulation
      4. Providers
      5. Business
      6. Agencies
    2. Federal government
      1. Policy
      2. Finance
      3. Management
      4. Center for Medicare and Medicaid Services
  3. Insurance
    1. Medicare
      1. Adults 65 and over
      2. Younger with disability
      3. Part A
        1. Hospital coverage
      4. Part B
        1. Medical services
      5. Part C
        1. Allows choice of coverage
      6. Part D
        1. Prescription coverage
    2. Medicaid
      1. Low-income
        1. Children
        2. Parents of eligible children
        3. Seniors 65 years
        4. Disabled
      2. Pregnant women
    3. Community Medicaid
      1. Little to no insurance
    4. Private Insurance
      1. From employer
    5. Self-Pay
      1. Pay provider directly
  4. Barriers
    1. Prevent access
    2. Causes delay/absence  of care
      1. Increase  stress
      2. Increase hospitalizations
        1. Longer stay
        2. Higher costs
    3. Financial
    4. Social
      1. Education
      2. Culture
        1. Language
      3. Stigmas
    5. Accessibility
      1. Transportation
      2. Location
    6. Attitudes
      1. Toward system
      2. Toward providers
    7. How are we addressing this?
      1. Telehealth
        1. Virtual care
        2. Addresses accessibility issues
      2. Urgent care centers
        1. Address clinician availability
      3. Nurse role
        1. Stay informed
        2. Advocate
          1. Help address inequalities
          2. Support efforts

Assessment

n/a

Therapeutic Management

n/a

Nursing Concepts

  1. Healthcare Organizations
  2. Patient-Centered Care
  3. Quality Improvement

Patient Education

n/a

Reference Links

Study Tools

Video Transcript

Video Transcript

Hi guys. Welcome to the lesson on access to care. Part of being a community health nurse is understanding that some people have difficulty accessing healthcare and the impact it has on the overall wellness of a community. We’ll discuss all that in this lesson and then some. So, let’s get started.
So what does access to care really mean? It’s our ability to use health services with regard to locating, receiving  and paying for them.  We will talk shortly about how these tie together. We want everyone to have the ability to utilize the most appropriate care when they need it because we know that’s how we maintain wellness and obtain the best possible health outcomes. Now health services can be anything from the primary care doctors to nursing home care, and we’re talking about quality care here.

Access to care is actually divided into four components. Services refers to the primary care provider and their ability to take on patients. The first question we ask when we are searching for a new physician is “are you taking new patients?” We are accessing that first component. Next is coverage and this refers to whether or not the patient has insurance. Timeliness means that we are receiving care as soon as it’s needed. So someone having a stroke or heart attack would need pretty quick access to healthcare. Delaying care would be detrimental. The last component is workforce and this refers to the availability of person-centered, culturally competent providers. Now this includes all providers, we’re not just talking doctors here.

So who sees to it that quality care stays accessible? All healthcare oversight comes from our government. The government performs audits and inspections, and they discipline providers and agencies as needed. Now, there are levels to the government and they are responsible for oversight differently. The local and state government typically work together to monitor and regulate healthcare and they’re also responsible for disease control. So there are aspects of healthcare that are universal but every state works differently when it comes to other aspects because they are the ones in charge. You wouldn’t necessarily see New York doing the same things as say Nebraska because they don’t have the same population, diseases and some of their standards of care may differ. Now the federal government on the other hand is responsible for policy, finance and management of healthcare and its resources. There’s a trickle-down effect from federal to state and local. So we mentioned insured vs. uninsured patients earlier also. The Centers for Medicare and Medicaid Services, or CMS, falls under the federal government as well and they are in charge of Medicare and Medicaid regulations.

So now we’ve mentioned it, may as well talk about it for a second. Medicaid and Medicare are insurances we associate with the older population but it’s actually a misconception. Both are intended for adults age 65 or older and the disabled, however, Medicaid focuses on low-income individuals: children, disabled, seniors, parents of qualifying children and pregnant women, while Medicare does not. The big difference here is how Medicare divides it’s coverage into parts.  Part A covers hospital visits and stays. Part B covers medical expenses like doctor visits, some medical equipment, lab tests, and so on. Part C is where the patient can choose their health plan within the same coverages as A & B. Part D covers prescription medications. Also something to note here, Medicaid also offers what’s called Community Medicaid which offers coverage to those with little to no insurance.

Some other coverages include private insurance which you choose through your employer. Usually you have a co-pay or deductible you meet every year to cover your costs. Self-pay means just that. There is no insurance coverage and you pay the provider directly. Believe it or not, some people do choose this option. It’s easier for some because maybe they only see a doctor once a year and they don’t want to pay for coverage they don’t feel they need. However, there are providers that don’t accept self-pay. They  will either allow it with full payment at the time of the visit, or not at all because they can’t guarantee they will actually be paid otherwise. So self-pay may sound great, but it can definitely limit your options. 

So what happens when you don’t have access to healthcare? Well, it can cause a delay or absence of care and the effects here are no good. It increases hospitalizations that may have otherwise been unnecessary and can potentially create higher healthcare costs due to longer hospital stays. Why? Because people with chronic conditions that don’t have access to treat the condition in the community will likely not thrive very well and their symptoms get worse as untreated time goes on.

So we know what the barriers cause but what are they? Now these aren’t all of them, but definitely the most frequently seen. Financial barriers: how many commercials do you see where someone says they can’t afford their medications? It’s not just a commercial, guys. The lower your income, the less likely you are to seek care. Social barriers like education, health literacy, cultural barriers and stigmas are huge. We see stigmas mostly with mental health care, but it does happen in other areas, particularly if you come from a specific cultural background. Now accessibility can refer to geographical location and the distance between home and care. Do you see any of these barriers linking to each other? How about this: I live in a rural area and don’t make a lot of money and my doctor’s office is 20 miles away but my vehicle doesn’t run properly. I see several barriers here and they all overlap. So the last barrier we’ll talk about is attitudes. We’re talking about patient attitudes now toward the healthcare system and toward providers. Maybe I had a bad experience at my primary doctor’s office and it turned me off. It didn’t necessarily have to be with the doctor, it could have been the receptionist or the nurse. Either way now I have an opinion and I’m not going back. I’m so turned off, I’m not interested in looking for a new doctor right now but I have a chronic condition. See how that could be a problem?

So what’s being done to address some of these barriers? We’ll talk about telehealth in the technology & informatics lesson but I want to give you a quick overview here. Telehealth is virtual care and it answers the financial, social and accessibility barriers we talked about. Urgent care centers and walk-ins are popping up everywhere and it helps with clinician availability and timeliness because they are open after regular business hours so I don’t have to sit in the ER for hours when I stub my toe.

What’s the nurses’ role in access to care? This answer is going to be a little different this time. First off, we have to stay informed so we can advocate for our communities. How do we do this? We identify the problems and do what we can to address them. We also support the efforts being made toward bridging the gap and ensuring access to everyone. 
So let’s review. Access to care means we use quality health services available to us. But barriers prevent us from doing that. Instead they delay care and increase otherwise unnecessary hospitalizations. And as nurses, we have to educate ourselves, advocate and support the efforts being made to ensure communities have what they need to obtain wellness.
That’s all for the Access to care lesson. Make sure you check out all of the resources attached to this lesson. Now, go out and be your best self today! And, as always, happy nursing! 

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