Basic Health Access

Workforce discussions, conferences, grants, and articles are reliable in one key area - lack of discussion of the requirements for true reform. The workforce blinders will be on and the focus will be on training interventions - interventions that cannot work because of the financial design. There will not even be discussion of the real reason for maldistribution. The big players have wiped this off of the table either by intention or by lack of awareness. There are so many other better options - for them. They prefer expansions of insurance or expansions of graduates or special innovative payments or special innovative training. Most Americans need and entirely different training design, an entirely different payment design, and most likely both for recovery of their basic access to health. If you understand what is proposed, who proposes the solution, and why - there can be clarity If you understand how payment designs are crafted, those who benefit in top concentrations of workf...

Journalists and researchers find common ground in dramatic presentations that illustrate the extremes of those doing best or those doing worst. What works to gain publication or to reap advertising revenue does not help in understanding disparities - especially those shaped by the health care design.   Choosing the worst county is a poor choice because these counties are so few and so atypical. Rural counties are also atypical as the counties have lowest concentrations of people, but not necessarily other demographics. A measure more consistent in health representation can be helpful in understanding disparities in outcomes. Categorizations that compare counties by concentrations of physicians illustrate important concepts regarding health workforce, outcomes, insurance, and demographics.    Few Ahead and Many Behind   There are only about 5 - 10 counties in most states - that have higher to highest concentrations of  physicians and health spen...

Foundation, association, and government leaders keep saying that access to care is about insurance. This "access is insurance" focus has wasted the 2010 reform effort for the purpose of restoring access. Access to care requires interactions between patients and health care team members. This requires the existence of local workforce to be available for any hope of access. Access is still lower or missing for most Americans because workforce is lower or missing where most Americans reside.   Leaders immersed in concentrations could assume that access is about insurance. Their web sites and reports promote insurance as the access solution. Where health care dollars and where health care workforce are most concentrated, it is entirely possible that expansions of Medicaid improved access where a few people were able to get insurance and also could engage health workforce and the necessary transportation. But this is only because these concentrations of workforce are su...

Health care designs helped rebuild health access 1965 to 1978 via JohnsonCare. Many of the current Red Counties were blue back then but have since switched. Health care designs 1980 under ReaganCare slashed and burned health care in Red Counties as seen in hundreds of closures of small and rural practices and hospitals. Designs 1990 - 2010 have also failed for Red Counties. Health care designs under ObamaCare 2010 to 2017 were worse for Red Counties already getting the least and compromised the most. Out of the Frying Pan into the Fire Health care is only one of many frustrations for those who feel that the established designs are failing. It is likely that Lowest Concentration counties will remain most frustrated by lack of design change. Health care designs 2017 to 2021 are likely to make situations worse for Red Counties. Red and Blue Lowest Concentration Are Similar - The Red Counties are bound together by many similar environments, situations, and determinants of health. ...