Transcript HSA3111_11_special_pops - University of Central Florida

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115th Anniversary of
the Discovery of X-Rays
HSA 3111: Healthcare for Special Populations
Topics
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Special Populations
Ethnic Divisions
The Uninsured
Children
Women’s Health Issues
Rural Health Issues
Homelessness
Mental Health Issues
HIV / AIDS
“These population groups are more vulnerable than the general population and
experience greater barriers in access to care…”
Text, p. 428
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Special Populations
• “Special Populations” as used in the text refers to
– Identifiable groups
– Having challenges achieving the average level of
health
• Special medical needs
• Difficulty obtaining healthcare
– Higher levels of vulnerability
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
3
HSA 3111: Healthcare for Special Populations
Special Populations (cont.)
• It is critical in the chapter to look at the causal
relationship between the groups and the
challenges
– We must not assume (without investigation) that
the identifying characteristic of the group is the
cause of the challenge
– The true causal relationship is the issue that must
be addressed
– Focusing on the identifying characteristic of the
group may not lead to effective remedial programs
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
4
HSA 3111: Healthcare for Special Populations
Special Populations (cont.)
• What sorts of population identifiers does the
chapter use?
– Ethnic
– Insured vs. uninsured
– Age (children, adults, the elderly)
– Gender
– Rural vs. urban
– Homeless
– The Chronically ill
– HIV/AIDS Sufferers
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
5
HSA 3111: Healthcare for Special Populations
Ethnic Divisions
• Consider the divisions in Tables 11-1—11-4 and
Figures 11-1—11-8
– How many of the disparities in outcomes are
attributable to access to medical care?
– How many are attributable to lifestyle?
– Are there inherent characteristics of any ethnic
group that create healthcare challenges
• Independent of income
• Independent of education
• Etc.
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
6
HSA 3111: Healthcare for Special Populations
Ethnic Divisions (cont.)
• Additional Data*
Avg. Income
% No Health Insurance
2009 Income and Insurance Data
White NH
Black
Asian
$54,460
$32,584
$65,469
12.0%
21.0%
17.2%
Hispanic
$38,039
32.0%
• What data would we need to see to determine
causality of health disparities?
NH = Non Hispanic
* Source: Income, Poverty, and Health Insurance Coverage in the United States,
U.S. Bureau of the Census
http://www.census.gov/prod/2010pubs/p60-238.pdf
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Ethnic Divisions (cont.)
• Asian American Populations
– Staggering heterogeneity in this population group
– Wide variation in immigration waves by country or
origin
• First generation immigration waves
• Eighth (or more) generation waves
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
8
HSA 3111: Healthcare for Special Populations
Ethnic Divisions (cont.)
• Native Americans
– 2.9 million in 2005 (< 1% of the population)
– Share characteristics of rural HC (later)
– Twice as likely to be poor, unemployed, and have
no college degree as others where they live
– Native Americans have special funding sources
for HC improvement
• But population growth is overwhelming
resources
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
9
HSA 3111: Healthcare for Special Populations
The Uninsured
• In 2009 50.7 million (16.7%) of Americans were
uninsured (Census Bureau)
– Most of the uninsured are neither unemployed nor
poor enough to qualify them for federal or state
programs such as Medicaid. (p. 442)
– Only 1/10 of uninsured people are uninsured by
personal choice
– Most uninsured do not have access to or cannot
afford employer-sponsored health insurance
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
10
HSA 3111: Healthcare for Special Populations
The Uninsured (cont.)
• Impact of no insurance on healthcare
– Chronic underutilization of existing resources
– “Systematic barriers” to HC
• 42% report no regular HC provider
• Few resources to pay medical bills
• Managed care reducing available of free or
reduced cost care
– 47% of uninsured reported postponing HC in one
year → Worsening condition when treated
– Uninsured increase the cost of HC for the insured
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
11
HSA 3111: Healthcare for Special Populations
Children
• The demographics of HC for children span the
issues already discussed
– Income
– Ethnicity-specific factors
– See Table 11-5 for impact on childhood
vaccination rates
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
12
HSA 3111: Healthcare for Special Populations
Children (cont.)
• Impacts of diminished HC for children
– Impaired learning with long-term social
consequences
– Lower vaccination rates have population
consequences
– Lack of sick-child care means more sick children
are sent to school → More sick children
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
13
HSA 3111: Healthcare for Special Populations
Children (cont.)
• Political Issues
– Children don’t vote
– They are dependent on other champions
– SCHIP (Balanced Budget Act of 1997) created
additional matching funds for uninsured child HC
• Works like Medicaid
• Higher income threshold for eligibility
• States must pay for federal matching dollars
• Only applies to uninsured children
– Violence against children being treated with
increasing vigor by society
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Women’s Health Issues
• Note the overwhelming morbidity differences
between men and women
– Higher death rates after heart attack or stroke
– 25% more activity-restricted days/year than men
– 34% more bed-ridden days/year than men
– 2-3 times more likely to suffer from anxiety
disorders or major depression than men
– Higher incidence of Alzheimer’s disease among
older women than older men
• But women living an average of eight years
longer than men
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
15
HSA 3111: Healthcare for Special Populations
Women’s Health Issues (cont.)
• Women have historically had “less attachment to
the labor market” and therefore less anchoring to
employer-sponsored health insurance
– More likely to work part time with no benefits
– More susceptible to losing benefits through
divorce
• Poorer women who may have been eligible for
Aid To Families with Dependent Children saw this
assistance decoupled from Medicaid
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Women’s Health Issues (cont.)
• Reproductive Health
– Insurance plans have been very slow to add
contraceptives to covered medications or
treatments
– Erectile dysfunction treatments were more widely
covered
– Some states are forcing insurance plans to cover
family planning
– Women face higher out-of-pocket costs because
of non-covered reproductive health costs
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
17
HSA 3111: Healthcare for Special Populations
Rural Health Issues
• Rural populations also share characteristics we
have seen before
– Increased incidence of poverty
– Ethnic distributions with attendant income issues
– Farmers often self-employed small businesses
with no employer-sponsored HC
• A risky profession
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
18
HSA 3111: Healthcare for Special Populations
Rural Health Issues (cont.)
• Some new HC issues
– Dispersed populations make access to HC and
HC delivery more difficult
– Lack of population density affect HC market
• Difficult to attract physicians
• Fewer specialists
• Hospital funding impacted
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
19
HSA 3111: Healthcare for Special Populations
Rural Health Issues (cont.)
• Numerous programs developed to address rural
HC issues
– National Health Service Corps provides physicians
for underserved areas
– Health Professions Shortage Areas
• Provide increased Medicare payments
• Other federal and state benefits
– Medically Underserved Areas
• Receive federal support for HMOs serving
underserved areas
• Receive C/MHC funding (next slide)
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Rural Health Issues (cont.)
• Rural programs (cont.)
– Community and migrant health centers
• Cover medically underserved areas
• Provide primary care and preventive services
• Different provisions for community vs. migrant
care centers
– Rural health clinics act supported underserved
areas in various ways including special
reimbursement programs
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Homeless Health Issues
• Homelessness is a multifaceted issue
– Approximately 1% of the population will be
homeless in a given year
– 39% are children
– 33% of the overall homeless population are
families with children
– 1/2 have not graduated from high school
– 20% have some sort of income maintenance
– 26% have some health insurance
– Federal help prohibited to individuals with no
physical street address
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
22
HSA 3111: Healthcare for Special Populations
Homeless Health Issues (cont.)
• Other challenges to healthcare access
– Overlap other population groups and share the
same issues
• Low income
• Children
• Women
– Large numbers with mental health difficulties
– Mobility impedes longitudinal care
– Large numbers with substance abuse difficulties
– Greater risk of assault
– Exposure to weather and unsanitary conditions
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
23
HSA 3111: Healthcare for Special Populations
Homeless Health Issues (cont.)
• Use of the healthcare system
– Underutilize ambulatory care
– Over utilize hospitalization
– But still use high proportion of outpatient services
– Lack transportation
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
24
HSA 3111: Healthcare for Special Populations
Homeless Health Issues (cont.)
• Remedial programs
– Federal Health Care for the Homeless Program
– Community health centers with private and
government support
– Mental health programs for homeless
– Homeless families program
– Most programs rely on outreach
• Actively seeking out the population at risk
• Address barriers to healthcare
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
25
HSA 3111: Healthcare for Special Populations
Mental Health Issues
• One in five Americans has a mental disorder in
any one year
• Huge numbers of people do not receive the help
they need for their conditions
• Multiple causes
– Medical
‒ Psychological
• Barriers to treatment
– Stigma
‒ Awareness
– Lack of supply
‒ Inadequate delivery
– Financial barriers
‒ Lack of individualized
treatment
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Mental Health Issues (cont.)
• Providing mental health care
– Most mental health care is provided in the general
medical sector
– Overall care consists of multiple components
• Primary care providers
• Specialty mental health services
• General counseling services
• Non-medical advisors
• Specialty inpatient facilities
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
27
HSA 3111: Healthcare for Special Populations
Mental Health Issues (cont.)
• Mental health care for the uninsured
– State hospitals
– Community and county mental health clinics
– Local governments are providers of last resort
• Mental health care for the insured
– Growing infrastructure of treatment facilities
– National chains of facilities
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
Mental Health Issues (cont.)
• Managed care and mental health services
– Traditional MC programs often limit MH services
– Providers are responding to multiple pressures
– Governments moving to MC programs for serviced
MH populations
– Specialized MC mental health services
organizations have developed in response to
• Needs
• Cost pressures
– Apply MC principles to MH case management
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
HIV / AIDS
• HIV / AIDS transitioned from an always fatal
condition to one which can be managed for many
patients
– Treatments require
• Early diagnosis
• Complex treatments
– Patient self-management
• Expensive medication
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
HIV / AIDS (cont.)
• Complexity places burdens on traditionally
underserved groups
– Economically challenged
– Undereducated
– Uninsured
– Mentally or emotionally challenged
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
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HSA 3111: Healthcare for Special Populations
HIV / AIDS (cont.)
• Social impacts
– Acute stages of advanced AIDS in the uninsured
– Likelihood of developing drug resistant strains
– Infected children
– Inequitable impacts on ethnic groups that share
contributing challenges to infection and treatment
– Shifting patterns of infection
• Women becoming equal opportunity victims
– AIDS stigma
Dr. Lawrence West, Health Management and Informatics Department, University of Central Florida
http://systems.cohpa.ucf.edu/lwest
32