Basic Health Access

The Myth of Coverage Equals Care Political cartoons lampoon one side or the other with ACA a common topic. A popular cartoon from Being Liberal depicts the Elephant in therapy after realizing the lack of failure of Obamacare, resulting in treatment for depression - a mental health condition which is covered under ACA. While intended for humor, the cartoon fails to raise the most important awareness: More than coverage is required for needed care delivery. The elements of the carton:  Realizing - Those not able to gain awareness, will have a difficult time with therapy. Awareness of basic care needs has failed for Republics and Democrats for some time. ACA isn't a failure, but it is not a success - especially in needed care areas Depression may be "covered," but just try to find mental health care providers and services, or get approval for same from your "insurance" coverage. Pay remains insufficient for primary care, for mental health, an...

(And other 3 letter acronyms representing failure for the past three decades) A nation divided continues to either promote ACA or protest it. Regardless of pro or con, many barriers to care remain as with health care designs 1983 to 2014 and beyond. This post was stimulated by a recent family medicine piece reviewed situations facing practices in Sugar Land and Arlington in Texas. It is true that all practices face the challenge of patients who do not understand how insurance works. But there are substantial health access barriers that remain and ACA may actually complicate health access for those in need of care. Focus must be returned to the substantial health access failures with minimal distractions. It is frustrating to see illustrations of practices in wealthier areas such as Sugar Land Texas. At these locations FM competes with a wide range of other providers for patients with insurance coverage better than ACA, Medicaid, and Medicare. It is not a surprise to see fam...

Health care articles commonly indicate that health care has been taken out of the hands of physicians and others who provide care. Not just the red states in this Bad Medicine map are suffering by design.   All states have been seeing red since 1983 (not just the 35 on the map). During the 1980s the cost cutting approach was established as the predominant modus operandi in US health policy. Most of the people in WA, OR, CA, NV, NM, CO, WY, IL, ME, MA, NY, NJ, NH, VT, and MD also suffer from the national and state cost cutting as seen in the states colored red. Bad Health Care Has Been Sweeping the Nation, not just Bad Medicine (see link below). My recent article Preventing Rural Workforce By Design reviews the many ways that our designs compromise health care where needed - and in more than just rural locations. When did health care design and domestic policy get refocused on more for less for less result for the nation? When did we depart designs for health care foc...

Teaching Community Health Center sites are a new innovation in graduate medical education (GME). Teaching CHCs have been set up to address failures in traditional GME in important health access areas - primary care needs, rural training, and the needs of states with fewer physicians. In general the states with highest concentrations of physicians have the most GME, the most specialized GME, the most clinicians of all types, and the highest spending on medical education and health care. Teaching CHCs have been announced and it is possible to assess 65 sites with regard to future health access workforce impact.  Will Teaching CHC Sites Deliver on their Promise of Needed Health Access Result? Yes, but limited - The best answer is that the Teaching CHCs will have some small impact, but the full potential will not be realized. Changes should be specific to better site choices and greater focus upon graduates that will deliver health access where needed. Local access impro...