The Healthy People 2020 Objective and how it affects access to health care.

1. A Presentation by: Cynthia Brown, MBA, RHIT, CCS

2. Healthy People 2020 Objective:
Emphasize the role of community partners
such as businesses, local governments, and
civic, professional, and religious organizations
as effective agents for improving health in their
local communities (Shi & Singh, 2010).

3. Healthy People 2020
“Health for All”
Increase quality
Promote healthy
and years of
behaviors
healthy life
Eliminate health Promote healthy
disparities communities
Prevent/Reduce
Diseases and
Disorders

4. Access to Care Defined
The ability to obtain
needed, affordable,
convenient, acceptable ,
and effective personal
health services in a timely
manner (Shi & Singh,
2008).

5. Key Implications of Access
 Key determinants of health, along with environment,
lifestyle, and hereditary factors.
 Significant benchmark in assessing the effectiveness of
the medical care delivery system (Healthy People 2020,
performance/accountability of health care plans and
providers.
 Determines whether or not delivery of health care is
equitable.
 Linked to quality of care and efficient use of needed
services (Shi & Singh, 2008).

6. Access to Health Services
Topic Areas
 AHS-1 Increase the proportion of persons with health
insurance (Medical, Dental, & Prescription Drug).
Target: 100% Baseline: 83.2%
 AHS- 2 Increase the proportion of insured persons
with coverage for clinical preventive services.
 AHS-3 Increase the proportion of persons with a usual
primary care provider.
Target: 83.9% Baseline: 76.3%

7. Access to Health Services
Topic Areas
 AHS-4 Increase the number of practicing primary care providers
(medical doctor, doctor of osteopathy, physician assistant, &
nurse practitioner)
 AHS-5 Increase the proportion of persons who have a specific
source of ongoing care.
5.1 All ages.
Target: 95% Baseline: 86.4%
5.2 17 years and under
Target: 100% Baseline: 94.3%
5.3 Adults 18 to 64
Target: 89.4% Baseline: 81.3%
5.4 Adults 65 and older
Target: 100% Baseline: 96.3%

8. Access to Health Services
Topic Areas
 AHS-6 Reduce the proportion of individuals who are
unable to obtain or delay in obtaining necessary
medical care, dental care, or prescription medicines.
 AHS-7 Increase the proportion of persons who receive
appropriate evidence-based clinical preventive
services.
 AHS-8 Increase the proportion of persons who have
access to rapidly responding pre-hospital emergency
medical services (basic life support, advanced life
support).

9. Access to Health Services
Topic Areas
 AHS-9 Reduce the proportion of hospital emergency
department visits in which the wait time to see an
emergency department clinician exceeds the
recommended timeframe (all visits, immediate,
emergent, urgent, & semi-urgent).

10. Dimensions of Access
Availability-fit between service capacity and individual’s
requirements (Shi & Singh, 2008).
Examples:
• Primary or preventive services available
• Transportation, language, & social services available
• Sufficient specialists
• 24/7 availability of primary care services
Accessibility-fit between locations and providers
Examples:
• Private/Public Transportation
• Disabled/Elderly accessibility
• Payment Options (Medicare, Medicaid, cash)

11. Dimensions of Access
Affordability-individual’s ability to pay.
Examples:
• High insurance premiums
• Co-payments/deductibles reasonable
• Prescription prices affordability
Accommodation-the fit between how resources are
organized to provide services and the individual’s ability
to use the arrangement.
Examples:
• Appointment availability; Office hours compatibility
• Routine appointments within 1 week; walk-ins services
• Urgent cases seen within 1 hour; non-emergency within 1 day

12. Dimensions of Access
Acceptability-compatibility between patients’ attitudes
about providers’ personal and practice characteristics,
and providers’ attitudes toward their clients’ personal
characteristics and values.
Examples:
• Waiting time for scheduled appointments
• Patients encouraged to ask questions and review
records.
• Acceptance of patients/providers regardless of race,
religion, or ethnic origin.

13. Barriers to Access
 Geography
 Financing
 Culture
 Race
 Language (Shi &
Singh, 2010)

14. Persons Likely to Face Access Problems
 People without health
insurance
 Minorities
 Low-income individuals
 People with little formal
education
 People with special
needs/Disability
 People with chronic
illnesses

15. Solution to Access Disparity
Patient Protection and Affordable Care Act
(Democrats, 2011):
• Quality, affordable health care for all Americans
• The role of public programs
• Improving quality/efficiency of health care
• Prevention of chronic disease and improving public health
• Health care workforce
• Transparency/program integrity
• Improving access to innovative medical therapies
• Community living assistance services and supports
• Revenue provisions

16. References
Democrats.Senate.gov. (2011). Responsible reform for the
middle class: The patient protection and affordable
care act, detailed summary. Retrieved from
http://dpc.senate.gov/healthreformbill.
Shi, L. & Singh, D.A. (2010). Essentials of the U.S. health
care system (2nd ed.). Sudbury, MA: Jones and Bartlett
Publishers.
Shi, L. & Singh, D.A. (2008). Delivering health care in
America: A systems approach (4th ed.). Sudbury, MA:
Jones and Bartlett Publishers.