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Equal/Universal Access

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Introduction:

"Equitable Access" means that people are guaranteed the same level of health care as other people. What is available to one person is available to everybody, and so on. Normally this would apply up to a set limit of minimal health care. One would have to pay for anything beyond that.

James Todd is one proponent of this system. He claims we should "define a basic level of health care to which everyone is entitled, supported by multiple funding systems." Todd suggests adding a government subsidy for people who are above the poverty line, but who cannot afford necessary treatment.

Another concept of "equitable access" allocates treatment based on medical needs and the resulting benefits. This might not mean everybody will get the same types of treatment, but instead it will be equal relative to the resources available, the health of the individual, and the expected outcome of treatment. Thus, everyone is guaranteed an "adequate" level of treatment, but not necessarily the same type or amount of treatment as somebody else.

Needless to say, "equal" access based on benefit would minimize the care given to the elderly or terminally ill. Their expected benefit would be less than that of someone younger.

Below are some examples of Inequality in Health Care, stemming from prejudice, misunderstanding, and society's reluctance to deal with certain types of people. Sometimes we neglect people because we feel they "don't deserve" care, or because the costs of care outweigh the benefits. The notion of equal access requires that we abandon our personal judgments and fulfill our societal obligation to others.

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Patients of Uncertain Life Expectancy Lack Care

Patients dying of diseases of unpredictable life course are being denied hospice care. This reflects a growing trend in our health care system. Insurance companies and HMO's are less willing to cover individuals who are likely to develop costly medical conditions. In effect, patients are being denied access to medical care just when they need it most. This tactic has helped insurers to cut costs, at the expense of human life. (See "Cost")

As the life expectancies of patients with chronic illnesses such as congestive heart failure, chronic obstructive pulmonary disease and end-stage liver disease are "nearly impossible to predict with any accuracy," many of those patients may have been denied Medicare hospice benefits, according to a study in today's Journal of the American Medical Association.

Government guidelines require that a doctor and hospice director certify that a patient has no more than six months to live before granting Medicare hospice benefits.

The researchers note that a "likely implication of this study is
that the goal of determining in advance -- with a high degree of accuracy
...which individual patients will die within 6 months is unrealistic
"

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HEALTH CARE BEHIND PRISON BARS PLAGUED BY
PROBLEMS OF ACCESS, QUALITY AND COSTS

Washington, D.C., Sept. 1, 1999-The 5.9 million Americans in jail, prison, on parole or on probation may represent the only population group entitled to appropriate medical care while under state supervision. But the delivery of health care in the country's correctional systems is not cost-effective, it is not adequate in quality and it does not serve the public interest.

According to the lead article in a special issue of the Journal of Health Care Finance,
the major problems in health care delivery in correctional institutions include:
1.) A growing correctional population of men and women

2.) Complex health care problems such as substance abuse,
HIV and other diseases
3.) Side-effects of Medicaid policy choices in recent years

Pollack said inmates are "out of sight and out of mind" as far as the general public is concerned "yet their health care challenges deserve public attention. We have to decide whether criminal offenders are individuals, who merely require supervision, or they are individuals who require treatment for their health care needs in substance abuse, HIV and other disorders while they are entirely under state supervision. Correctional institutions have not addressed either viewpoint satisfactorily."

"This is an extreme example of the problems of correctional care.
It represents the overall problem of providing adequate health care
to a population that contains severely disadvantaged individuals
facing substance abuse and other chronic conditions."

Altice adds "if we provide inadequate medical care to inmates with substance abuse and other behavioral health problems, we lose the opportunity to prevent predictably dangerous and costly behaviors, both within the correctional facilities as well as within the general community where large numbers of probationers and parolees are found. Criminals often face substance abuse-related problems, including sexually transmitted diseases, HIV, and tuberculosis.

"Managed care can provide some solutions, but at least one aspect of managed care, strongly capitated payment, is likely to produce unacceptable risks in providing adequate care to supervised offenders."

"Supervised offenders do not use health care in the same way as the
average citizen, who can demand services for both prevention and treatment."

"These inmates face barriers in accessing health care services. In the general community, most managed care patients can obtain 'out-of-network' care, through increased co-payments and other costs. These options are not available in most correctional settings, and because prisoners lack mobility, they often lack access to services easily obtained by other patients."

According to the article, providing continuity of medical care is another major problem for correctional institutions. Upon entering a jail or a prison, most inmates are disenrolled from Medicaid after the first month of incarceration. Few states have mechanisms to assure appropriate re-enrollment upon release from jail.
(see "Portability")

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Seniors Hardest Hit by HMO Withdrawal

There has been a recent rash of HMO withdrawals from Medicare and service cutbacks intended by many more.

"Most 'orphaned' Medicare beneficiaries have been able to find new coverage arrangements,
but many now
pay more and have fewer benefits." (Health Affairs, Nov./Dec. 1999)

Over 400,000 Medicare HMO enrollees have been forcibly dropped from their HMOs. The survey found that two-thirds of disenrollees had joined other Medicare HMOs, while the remainder had returned to traditional fee-for-service plans with or without supplemental coverage.

Almost 40% faced higher premiums, and over one-third of all disenrollees received fewer benefits. The most common result was that beneficiaries lost their prescription drug coverage, with one in six reporting no drug benefits after the transition. "The findings make it clear that while all beneficiaries are fortunate to have traditional Medicare as a safety net, gaps in the benefit package meant fewer benefits and high cost for many HMO disenrollees.

Low-income, disabled and those beneficiaries most in need of care were
hit hardest by the forced transition. Beneficiaries over age 85, the disabled under
65 years-of-age, older, racial and ethnic minorities, the poor and near-poor and
those with poor health were most likely to return to traditional Medicare with
no supplemental coverage, and disenrollees with low-income, poorer health
and non-Hispanic whites were most likely to lose drug coverage
.
(Health Affairs release, 11/8).

Continuity of care was also affected by recent events, the study shows, revealing that 22% of beneficiaries were forced to switch doctors. "Interestingly, though not surprisingly, those who enrolled in new HMOs were more likely to change doctors," Langwell explained, citing differing provider networks as the cause.
(See "Portability")

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