Access to Care

Psychophysiological diagnostic and therapeutic methods, to include biofeedback, have been found to be empirically effective in the treatment of a variety of physical disorders. In many areas of the country, however, certified biofeedback practitioners are not well distributed, limiting patient access to this treatment modality. Psychologists at Tripler Army Medical Center have pioneered efforts to develop and provide these needed

his chapter presents basic trends as well as research and policy issues related to health care access. We define access as actual use of personal health ser- vices and everything that facilitates or impedes their use. It is the link between health services systems and the populations they serve. Access means not only vis- iting a medical care provider but

Résumé

En abordant la réduction des inégalités sociales et territoriales de santé sous l’angle exclusif de l’amélioration de l’accès aux soins des populations les plus « vulnérables », les politiques et programmes de santé considèrent une seule dimension de ces inégalités, alors qu’elles traversent l’ensemble de la hiérarchie sociale. Or, si les disparités d’accès aux soins préventifs ne constituent pas le déterminant principal des inégalités sociales de santé, dans un modèle de soins français essentiellement curatif, elles ne sont pas négligeables dans leur production. Cependant, les mesures visant à élargir l’accès aux soins de prévention ne sont pas les seules à mettre en oeuvre pour réduire les inégalités sociales de santé, qui traversent l’ensemble de la hiérarchie sociale.

Abstract

Social Inequalities of Health : What Consequences for Access to Preventive Care ?

Seeking to reduce social and territorial inequalities of health by focusing exclusively on improved access to care for the most “vulnerable” population means that health policies and programmes take only one dimension of such inequalities into account, even though they are found throughout the social hierarchy. While access to preventive care is not the principal determinant of social inequalities of health, it is not a negligible factor in the production of such inequalities in a health care system such as France’s which focuses on cure.

Canada's health care system has undergone major changes since 1990. In Saskatchewan, 52 small rural hospitals funded for less than eight beds stopped receiving funding for acute care services in 1993. Most were subsequently converted to primary health care centers. Since then, concerns have been raised about the impact of the changes on rural residents’ access to care, their health status, and the viability of rural communities. To assess the impact of hospital closures on the affected communities, we conducted a multi-faceted, province-wide study. We looked at hospital use patterns, health status, rural residents’ perceptions of the impact of these hospital closures, and how communities responded to the changes. We found the hospital closures did not adversely affect rural residents’ health status or their access to inpatient hospital services. Despite widespread fears that health status would decline, residents in these communities reported that hospital closures did not adversely affect their own health. Although some communities continue to struggle with changes to health care delivery, others appear to have adapted as a result of strong community leadership, the development of widely accepted alternative services, and local support for creating innovative solutions. Good rural health care does not depend on the presence of a very small hospital that cannot, in today's environment, provide genuinely acute care. It requires creative approaches to the provision of primary care, good emergency services, and good communication with the public on the intent and outcomes of change.

America is a multi-cultural society. Yet, there are cultural dimensions to the clinician-patient relationship that have not been systematically addressed in medical education or in clinical practice. Lack of diversity and lack of cross-cultural skills in the medical profession may contribute to ...

African Americans experience disproportionate incidence and mortality rates from colorectal cancer (CRC). This health disparity is partially explained by low participation in screening. This study aimed to identify factors influencing adherence to colorectal cancer screening among African Americans. Telephone interviews were conducted with African Americans living in Maryland (57% response rate). A total of 504 respondents agreed to participate. The survey primarily assessed participation in CRC screening, health beliefs and attitudes about CRC screening, and demographics. Nearly 77% of respondents reported being adherent to CRC screening guidelines. Of those not adherent, nearly 50% reported not ever receiving a physician recommendation to be screened. Having health insurance was a strong correlate of adherence. Study participants with greater perceived CRC risk were more likely to be adherent. Further, those who reported that they were caregivers were less likely to be adherent to screening. Findings indicate that those who were the primary care takers of children or disabled persons were less likely to participate in CRC screening. Efforts are needed to ensure that caregivers do not neglect their own preventive health, including CRC screening. Further, access to care and health insurance coverage also appear to be an important factor for participation in CRC screening. Ensuring that those who do not have adequate healthcare coverage are not excluded from participation in CRC screening due to cost should be an important priority if reduction in CRC health disparity is to be achieved.