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February 2014
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Overview
Access to quality health services can have a profound effect on every aspect of a person’s health. When considering access to health services it is important to consider four distinct areas: coverage, services, timeliness, and workforce. Employment status is an important factor that is associated both with insurance coverage and overall health status. In 2009-2010, 48.1% of unemployed adults aged 18-64 years had health insurance compared with 81.4% of employed adults. Unemployed adults had poorer mental and physical health than employed adults; this pattern is found for insured and uninsured adults.1 With the implementation of the Affordable Care Act, more Americans, both employed and unemployed, will have access to needed health insurance than ever before.
Access to health care services depends in part on ensuring that people have a usual and ongoing source of care, especially primary care. People with a usual source of care have better health outcomes, reduced disparities across subgroups, and lower costs.2, 3, 4 Timely provision of quality health care after a need is identified is also a critical factor in improving overall access to health services. Despite progress in timely access to health services, disparities across populations continue to exist. Between 2002 and 2008, the percentage of adults who reported not getting care as soon as wanted was higher for poor, low-income, and middle-income people than for high-income people.5 Many of the issues seen in access to quality and timely health services are tied to the need for an adequate and well-trained workforce to provide needed health care services. Federal initiatives, including the Affordable Care Act, are addressing this need for increased workforce through investments in training and infrastructure.6
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Access to Health Services and the Affordable Care Act
With the implementation of the Affordable Care Act, millions more Americans have the ability to access quality health services. Under the Affordable Care Act, most health plans must now cover a set of preventive services for adults, women, and children at no cost to the patient. This means that many more Americans have access to preventive health care services and essential benefits to keep them healthy. To learn more about accessing quality health services through the Health Insurance Marketplace, please visit healthcare.gov.
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Leading Health Indicators
Leading Health Indicators (LHI) are critical health issues that – if tackled appropriately – will dramatically reduce the leading causes of death and preventable illnesses. The Access to Health Services LHIs are:
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Where We’ve Been and Where We’re Going
Over the past decade, the rate of persons aged under 65 years with health insurance has decreased 0.6%, from 83.6% in 2001 to 83.1% in 2012. The proportion of persons with a usual primary care provider also decreased, moving from 78.2% in 2000 to 77.3% in 2011, although this change was not statistically significant. Differences in rates of health insurance exist by race and ethnicity and level of educational attainment and in the proportion of persons with a usual primary care provider by race and ethnicity, level of educational attainment, and type of insurance.
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Who’s Leading the Leading Health Indicators?
St. Louis Integrated Health Network — Coordinating and Retaining Patient Access to Primary Care
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 Access to and utilization of quality health care greatly affects a person’s health. In particular, a usual and ongoing source of care leads to better health outcomes and fewer costs.7 However, in 2012, about 1 in 5 adults ages 18-64 did not have a usual source of care.8 In addition, patients benefit when their usual source of care is a primary care provider (PCP), as PCPs form relationships with their patients and increase the likelihood their patients will receive appropriate care.
When one of the major regional safety net hospitals in St. Louis, Missouri closed, key stakeholders and providers in the region came together under the umbrella of the St. Louis Regional Health Commission to address the lack of available services and to ensure that underserved populations would continue to have access to ongoing care. From their efforts, the St. Louis Integrated Health Network (IHN) was formed in 2003. The IHN is a regional network of safety-net providers that exists to:
- Integrate and coordinate services for its patients
- Link Medicaid and uninsured patients with a primary care home
- Reduce non-emergent emergency department use
The IHN has received support from federal agencies such as the Health Resources and Services Administration (HRSA) and the Centers for Medicare and Medicaid Services (CMS) to promote their work in the St. Louis area.
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