Healthcare Access, Insurance

The Institute of Medicine notes that progress in addressing several key health concerns is inhibited due to poor access to health care. The primary barrier to lack of access to health care is cost and/or lack of insurance. Patient access to high-quality primary care makes certain that critical health needs are met in a timely manner and preventative procedures are rendered including annual checkups, blood pressure screening, mammograms, papanicolaou tests, childhood immunizations, adult influenza vaccines, asthma screening, HIV testing, and more.  Thus, many policies and programs that influence wages and disposable income, transportation, health care coverage insurance, and other pathways ultimately affect health care access.Heath outcomes are directly affected by policies that affect health insurance coverage and access to health care or good quality of care.    Policies from other sectors, such as transportation, also affect health care access. For example, cutbacks in mass transit affect the availability of transportation options which limit mobility and access to care for many who rely on public transportation, particularly among low-income individuals, elderly, and children who cannot drive or cannot afford an automobile. Conversely, policies programs that provide services to the community such as monthly mobile clinics and employee mandated health insurance can increase access to care and reduce mortality rates.

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There are approximately 47 million Americans that are without health insurance according to the U.S. Census Bureau.  In part, this is due to fewer employers offering health care coverage to their employees as insurance costs outpace inflation and wage increases, and it is also due to the growing number of unemployed individuals.  In addition, the number of uninsured children between the ages of 12-17 continues to rise over the years.

Downstream Health Effects

Health outcomes are directly affected by policies that affect health insurance coverage and access to health care or good quality of care.

Policies and Other Determinants

Policies involving health care access and health insurance are becoming key agenda items among legislative bodies throughout the U.S.  Such polices help to draw attention to the growing number of uninsured, access to care, and the need for quality health care particularly among vulnerable and disadvantaged populations. For instance:

  • Living wage ordinances have the potential to reduce mortality rates and their associated costs by requiring employers to offer health insurance to all of their employees. Research shows that the associated health benefits from such ordinances are more cost-effective than equivalent wage increments; suggesting that health insurance coverage rates through a living wage ordinance can be a critical step towards promoting health   

  • Mass transit cuts have direct effects on transit service and can potentially have some downstream effects on health.  Low income and vulnerable populations that rely heavily on mass transit have a difficult time accessing health care services when mass transit options are altered or interrupted.  Polices that ensure mass transit funding can contribute to public health promotion efforts like access to care.