Basic Health Access

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...

The largest insurer in the nation is in a great position to lead the nation toward improvements. A major change in favor of primary care, mental health, and basic services could go a long way to restore basic health access - the foundation of an efficient and effective health care delivery system. Medicaid is the largest insurer in the nation. The problem with Medicaid may not be the amount of health care cost, but how the dollars are spent.  Payment increases for Medicaid could boost basic services for 70 million people insured by Medicaid and another 50 - 70 million in places where Medicaid is most dominant. This is because access is about local workforce to deliver basic services, not insurance expansion.  With more dollars invested in basic services through Medicaid, all of the people in places with lowest concentrations of access, workforce, and spending could benefit.  With lowest payments and fewer dollars going to locations with higher Medicaid patient le...

These are many areas of concern for those attempting to deliver health care. There are even more areas of concern regarding those in rural and smaller practices and facilities where growth is most in population, in elderly, in complexity, and in disparities. The concern list has been growing more rapidly since 2010. Ten Concern Areas for Populations Behind By Design and Their Providers 1 Chaotic, rapid, meaningless change is making it difficult for practices and facilities to support the team members to deliver care. Such change favors those bigger and more organized.  These are design changes that marginalize the teams that are supposed to deliver the care, especially for small health care. Populations already behind experience the changes most - along with most adversity. 2 Designs for payment increasingly lack clarity and overlap in confusing ways.  This raises serious concerns. In recent years, providers have had to sue the government or paye...

It takes specific local focus across most of the nation's population to get the health, education, and other societal outcomes that make us a better nation. One of the points made by de Tocqueville in his historical summary of American life over 150 years ago was the local focus of problem solving. As we have moved away from local to global focus,  our global attempts appear to fail more and more locally. Care for Americans most in need of care is not facilitated by those far away dictating, managing, legislating, reorganizing, innovating, or profiting. Health care outcomes are about local people, local life and home situations, local social determinants, decades of past life experiences, sufficient resources locally for needed care, and local providers best aware of the patient and the context of care who have also shared decades of life experiences locally. Can Americans balance the local and the global sufficient to the task of health care delivery? Leaders can lea...