Access to Health Care in America -- Copyright -- Contents -- Summary -- GENERAL CONCLUSIONS ON THE STATE OF ACCESS -- DEFINING ACCESS -- THE COMMITTEE'S INDICATORS AND PROGRESS TOWARD ACCESS OBJECTIVES -- Objective 1: Promoting Successful Birth Outcomes -- Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases -- Objective 3: Early Detection and Diagnosis of Treatable Diseases -- Objective 4: Reducing the Effects of Chronic Disease and Prolonging Life -- Objective 5: Reducing Morbidity and Pain through Timely and Appropriate Treatment -- RECOMMENDATIONS -- 1 Introduction -- BACKGROUND -- DEVELOPING A SET OF INDICATORS -- RELATIONSHIP OF ACCESS MONITORING TO OTHER RELEVANT ACTIVITIES -- MAJOR DATA SOURCES: THEIR USES AND LIMITATIONS -- Strengths and Weaknesses -- Vital Statistics -- Surveys -- Hospital Discharge Data -- Tumor Registries -- Reportable Diseases -- Claims Data -- CROSSCUTTING ISSUES -- Race/Ethnicity -- Timeliness -- REFERENCES -- 2 A Model for Monitoring Access -- DEFINING ACCESS -- MEASURING ACCESS -- Indicators -- Utilization Indicators -- Outcome Indicators -- Utilization and Its Relationship to Health Care -- Mediating Factors -- Barriers to Access -- Structural Barriers -- Financial Barriers -- Personal and Cultural Barriers -- The Relationship of Access Barriers to Indicators -- REFERENCES -- 3 Using Indicators to Monitor National Objectives for Health Care -- OBJECTIVE 1: PROMOTING SUCCESSFUL BIRTH OUTCOMES -- Utilization Indicator: Adequacy of Prenatal Care -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Infant Mortality -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Low Birthweight -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Congenital Syphilis -- Measuring the Indicator.

Trends in the Data -- Recommendations -- OBJECTIVE 2: REDUCING THE INCIDENCE OF VACCINE-PREVENTABLE CHILDHOOD DISEASES -- Utilization Indicator: Preschool Immunization -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Incidence of Vaccine-Preventable Childhood Diseases -- Measuring the Indicator -- Trends in the Data -- Recommendations -- OBJECTIVE 3: EARLY DETECTION AND DIAGNOSIS OF TREATABLE DISEASES -- Utilization Indicators: Breast and Cervical Cancer Screening Procedures -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Incidence of Late-Stage Breast and Cervical Cancers -- Measuring the Indicator -- Trends in the Data -- Recommendations -- OBJECTIVE 4: REDUCING THE EFFECTS OF CHRONIC DISEASES AND PROLONGING LIFE -- Utilization Indicator: Continuing Care for Chronic Diseases -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Utilization Indicator: Use of High-Cost Discretionary Care -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Avoidable Hospitalization for Chronic Diseases -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Access-Related Excess Mortality -- Measuring the Indicator -- Trends in the Data -- Recommendations -- OBJECTIVE 5: REDUCING MORBIDITY AND PAIN THROUGH TIMELY AND APPROPRIATE TREATMENT -- Utilization Indicator: Percentage of Healthy Individuals Who Do Not Contact a Physician During an Acute Episode of Illness -- Measuring the Indicator -- Trends in the Data -- Recommendation -- Utilization Indicator: Dental Services -- Measuring the Indicator -- Trends in the Data -- Recommendations -- Outcome Indicator: Avoidable Hospitalization for Acute Conditions -- Measuring the Indicator -- Trends in the Data -- Recommendation -- REFERENCES.

4 Future Indicators -- ACCESS TO HEALTH CARE FOR PEOPLE WITH DISABILITIES -- FAMILY VIOLENCE -- EMERGENCY SERVICES -- POST-ACUTE-CARE SERVICES FOR THE ELDERLY -- PRESCRIPTION DRUGS -- REFERENCES -- 5 Recommendations -- RECOMMENDATIONS -- Crosscutting Recommendations -- State and Local Monitoring -- The Federal Role -- Racial and Ethnic Differences -- FUTURE STEPS -- Objective 1: Promoting Successful Births -- Indicator: Prenatal Care -- Indicator: Infant Mortality -- Indicator: Low Birthweight -- Indicator: Congenital Syphilis -- Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases -- Indicator: Preschool Immunization -- Indicator: Incidence of Vaccine-Preventable Childhood Diseases -- Objective 3: Early Detection and Diagnosis of Treatable Diseases -- Indicator: Breast and Cervical Cancer Screening Procedures -- Indicator: Incidence of Late-Stage Breast and Cervical Cancers -- Objective 4: Reducing the Effects of Chronic Diseases and Prolonging Life -- Indicator: Continuing Care for Chronic Diseases -- Indicator: High-Cost Discretionary Care -- Indicator: Avoidable Hospitalization for Chronic Diseases -- Indicator: Access-Related Excess Mortality -- Objective 5: Reducing Morbidity and Pain through Timely and Appropriate Treatment -- Indicator: Acute Medical Care -- Indicator: Dental Services -- Indicator: Avoidable Hospitalization for Acute Conditions -- REFERENCE -- APPENDIXES -- A Developing Indicators of Access to Care: The Case for HIV Disease -- ROBERT WOOD JOHNSON FOUNDATION AIDS HEALTH SERVICES PROGRAM AND EVALUATION -- ISSUES IN ASSESSING ACCESS TO PERSONAL HEALTH CARE -- Financial Barriers -- Insurance Coverage -- Provider Reimbursement Rates -- Investment in Resources for Treating HIV Disease -- Structural Barriers -- Lack of a Primary Source of Care -- Lack of Appropriate Service Providers.

Distance from care Providers -- Extended Waiting Times for Providers -- Personal Barriers -- Attitudinal Barriers -- VIABILITY OF DEVELOPING ACCESS INDICATORS FROM EXISTING DATA SETS -- Decreased Mortality Using Case-Finding -- Reduced Mortality Using Medical Management -- Reduced Morbidity and Improved Function -- CONCLUSION -- REFERENCES -- B Developing Indicators of Access to Care: Waiting Lists for Drug Abuse Treatment -- METHODS -- THE NUMBER OF PERSONS ON WAITING LISTS -- ''THERE ARE NO REAL WAITING LISTS FOR TREATMENT" -- WAITING LISTS UNDERESTIMATE UNMET DEMAND -- SHOULD THERE BE WAITING LISTS? -- EMPIRICAL STUDIES OF WAITING LIST BEHAVIOR -- DISCUSSION -- FINAL COMMENT -- REFERENCES -- C Developing Indicators of Access to Care: The Case for Migrants and the Homeless -- MIGRANT HEALTH STATUS -- HEALTH STATUS OF THE HOMELESS -- RECOMMENDATIONS -- REFERENCES -- D "Ambulatory-Care-Sensitive" Conditions and "Referral-Sensitive" Surgeries -- Index.