MORE Health's mission is to offer you and your family access to the best medical minds We offer access to the world's best healthcare, when you need it most. Burnham, John C. Health Care in America: A history (), An American health dilemma: A medical history of African. Universal health care is a health care system that provides health care and financial protection . Funding models. See also: Health care economics. Universal health care in most countries has been achieved by a mixed model of funding.
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Access to mental health providers and services is a challenge in rural areas. As a result, primary care physicians often fill the gap and provide mental health services while facing their own barriers, such as lack of time with patients or adequate financial reimbursement. Mental Health HPSAs are scored , with higher scores indicating a greater need for mental health providers. The November map below highlights mental health HPSAs for both metro areas, in multiple shades of purple, and nonmetro areas, in various shades of green.
Due to the lack of mental health providers in rural communities, the use of telehealth to deliver mental health services is on the rise. Mapping the Evidence for Patient Outcomes from Systematic Reviews , found that mental health services delivered via telehealth have been shown to be effective. By using telehealth delivery systems, mental health services can be provided in a variety of rural settings including rural clinics, schools, residential programs, and long term care facilities.
RHIhub's Telehealth Use in Rural Healthcare topic guide has many more resources on how telehealth can improve access to care. For additional resources on access to mental health services in rural areas, see RHIhub's Rural Mental Health topic guide.
A shortage of mental health and substance abuse clinicians in rural communities led to the development of new models to bridge the gap and provide needed mental health and substance abuse services using allied behavioral health workers, such as:. The brief discusses and compares the provider to population ratios of the behavioral health workforce in metropolitan and nonmetropolitan U.
A state-level analysis of the study is also available with information for all states. Despite a growing need, there is a definite lack of substance abuse services offered in many rural communities across America. An Assessment of Treatment Quality by Location , reports that rural substance abuse treatment centers had a lower proportion of highly educated counselors, compared to urban centers.
Rural treatment centers were found to offer fewer wraparound services and specialized treatment tracks. Detoxification is an initial step of substance abuse treatment that involves managing acute intoxication, withdrawal, and minimizing medical complications.
The lack of detox providers in rural areas creates a barrier to care that could result in patients forgoing or delaying needed treatment. In lieu of a detox provider in a rural community, the local emergency room or county jail, although not the most appropriate location for detoxification services, must often serve as a substitute. Access to medication-assisted treatment MAT is also limited in rural communities.
Medication-Assisted Treatment for Opioid Use Disorder in Rural America provides an overview of MAT, an evidence-based treatment for opioid use disorder, with information on the science behind the disorder and how three MAT medications work. RHIhub's Substance Abuse in Rural Areas topic guide provides information and resources; answers frequently asked questions; and lists model programs to address substance abuse treatment in rural areas.
From to , rural counties lost hospital-based OB services, either to a hospital or OB unit closure. This results in only Of the rural counties losing OB services during that ten-year timeframe, were noncore counties, leaving just A committee opinion from the American College of Obstetricians and Gynecologists ACOG , Health Disparities in Rural Women , reports that prenatal care initiation in the first trimester was lower for mothers in more rural areas compared with suburban areas.
Access to labor and delivery, prenatal, and related services is also a concern of ACOG, reporting that less than one half of rural women live within a minute drive to the nearest hospital offering perinatal services.
Obstetric Services and Quality among Critical Access, Rural, and Urban Hospitals in Nine States , a policy brief from the University of Minnesota Rural Health Research Center, reports the results of a study assessing the quality of childbirth-related care in different hospital settings.
The study concluded that Critical Access Hospitals CAHs performed favorably on obstetric care quality measures when compared to urban hospitals, with some variation across the nine states. Oral health affects physical and emotional health, and has many other influences over our lives that affect health and wellbeing, such as obtaining employment.
Despite the importance of oral health, access to oral health services is either very limited or difficult to access in many rural and remote communities. Traditionally, medical or health insurance plans have not covered oral health services. A separate oral health or dental insurance plan is needed to cover oral health services and procedures. A National Academies of Sciences, Engineering, and Medicine report, Advancing Oral Health in America , states that fewer rural residents have dental insurance compared to urban residents.
Another factor limiting access to dental services is the lack of dental health professionals in rural and underserved areas. Residents , found that rural adults used dental services less and had more permanent tooth loss compared to urban adults, which could be related to the scarcity of dentists in rural areas. The per capita supply of generalist dentists per , population, based on data, was RHIhub's Oral Health in Rural Communities topic guide provides more information on oral health disparities in rural America and strategies being used to address those disparities.
The closure of rural healthcare facilities or the discontinuation of services can have a negative impact on the access to healthcare in a rural community.
Local rural healthcare systems are fragile; when one facility closes or a provider leaves, it can impact care and access across the community. For example, if a surgeon leaves, C-section access declines and obstetric care is jeopardized. If a hospital closes, it may be harder to recruit physicians. There are multiple factors that can affect the severity and impact of a hospital or healthcare facility closure, including:.
Traveling to receive healthcare services places the burden on patients. For individuals with low incomes, no paid time off of their jobs, physical limitations, acute conditions, or no personal transportation, these burdens can significantly affect their ability to access healthcare services. Rural hospital closures, particularly CAHs, frequently make the news with articles discussing the negative effects in particular for rural communities, such as:.
A significant concern for rural communities losing their hospital is the loss of emergency services. In emergency situations, any delay in care can have serious adverse consequences on patient outcomes. Rural health experts believe rural hospital closures are likely to continue because many rural hospitals have minimal operating margins with little room for financial loss. A Medicare Payment Advisory Commission presentation, Improving Efficiency and Preserving Access to Emergency Care in Rural Areas , describes policies and strategies to ensure access to emergency department services in rural areas.
The presentation provides discussion on alternative healthcare delivery models. See What alternative hospital models have been proposed to serve rural communities? Maintaining pharmacy services in rural towns can also be a challenge, particularly when the only pharmacist in town nears retirement. When a community's only pharmacy closes, it creates a void and residents must adapt to find new ways to meet their medication needs. Average characteristics of communities include:. For more information on rural pharmacy access or challenges rural pharmacies face, see RHIhub's Rural Pharmacy and Prescription Drugs topic guide.
There are multiple strategies being used to improve access to healthcare in rural areas. An Alternative Model for Rural Communities , further defines a FSED and describes the two types, while discussing the financial sustainability of the model.
Community Paramedicine is a model of care where paramedics and emergency medical technicians EMTs operate in expanded roles to assist with healthcare services for those in need without duplicating available services existing within the community. RHIhub's Community Paramedicine topic guide describes how this model of care can benefit rural communities and cover steps to starting a rural community paramedicine program. Frontier Community Health Integration Program FCHIP is exploring the development of and testing new models to improve access to quality healthcare services in frontier areas.
The Community Health Worker CHW model facilitates healthcare access by using CHWs as a liaison between healthcare providers and rural residents to help make sure their healthcare needs are met. A variety of rural medical home and care coordination programs are highlighted in RHIhub's Rural Health Models and Innovations section. The report also describes a range of different delivery options for communities that lack hospital inpatient care.
Local rural healthcare facilities may choose to join healthcare networks or affiliate themselves with larger healthcare systems as a strategic move to maintain or improve healthcare access in their communities. These affiliations or joining of healthcare networks may improve the financial viability of the rural facility; provide additional resources and infrastructure for the facility; and allow the rural healthcare facility to offer new or expanded healthcare services they could not otherwise provide.
However, the benefits of an affiliation with a larger healthcare network may come at the expense of local control. The brief found nonmetropolitan CAHs had the lowest rate increase in hospital system affiliation. The RUPRI Center for Rural Health Policy Analysis report, The Rural Hospital and Health System Affiliation Landscape — A Brief Review , discusses the various types of hospital affiliations that rural hospitals might consider and factors that might affect which option rural hospitals choose, such as maintaining local decision-making authority and meeting the demands of the hospital system affiliation.
The report covers some benefits hospital system affiliation can afford a rural hospital, including access to:. An adequate workforce is necessary to maintaining access to healthcare in a community. In order to increase access to healthcare, rural communities should be using their healthcare professionals in the most efficient and strategic ways.
This might include allowing each professional to work at the top of their license, using new types of providers, working in interprofessional teams, and creative scheduling to offer clinic time outside of regular work hours. RHIhub's Rural Healthcare Workforce topic guide discusses how rural areas can address workforce shortages, such as partnering with other healthcare facilities; increasing pay for staff; adding flexibility and incentives to improve recruitment and retention of healthcare providers; and using telehealth services.
The guide also discusses state and federal policies and programs to improve the supply of rural health professionals, such as loan repayment programs and visa waivers. Telehealth continues to be seen as a key solution to help address rural healthcare access issues. Through telehealth, rural patients can see specialists in a timely manner while staying in the comfort of their home or local facility. Local healthcare providers can also benefit from subspecialists' expertise provided via telehealth.
RHIhub's Telehealth Use in Rural Healthcare topic guide provides a broad overview of how telehealth is being used in rural communities to improve healthcare access. The ACA supports competition and has encouraged the entry of hospital-based plans, Medicaid managed care plans, and other plans into new areas. Some parts of the country have struggled with limited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan.
Public programs like Medicare often deliver care more cost-effectively by curtailing administrative over head and securing better prices from providers.
Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited.
Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government. There is another important role for Congress: While I have always been interested in improving the law—and signed 19 bills that do just that—my administration has spent considerable time in the last several years opposing more than 60 attempts to repeal parts or all of the ACA, time that could have been better spent working to improve our health care system and economy.
In some instances, the repeal efforts have been bipartisan, including the effort to roll back the excise tax on high-cost employer-provided plans. Although this provision can be improved, such as through the reforms I proposed in my budget, the tax creates strong incentives for the least-efficient private-sector health plans to engage in delivery system reform efforts, with major benefits for the economy and the budget.
It should be preserved. While historians will draw their own conclusions about the broader implications of the ACA, I have my own. These lessons learned are not just for posterity: I have put them into practice in both health care policy and other areas of public policy throughout my presidency. The first lesson is that any change is difficult, but it is especially difficult in the face of hyperpartisanship. Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported.
For example, they supported a fully funded risk-corridor program and a public plan fallback in the Medicare drug benefit in but opposed them in the ACA. They supported the individual mandate in Massachusetts in but opposed it in the ACA. Moreover, through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts. We could have covered more groundmore quickly with cooperation rather than obstruction.
It is not obvious that this strategy has paid political dividends for Republicans, but it has clearly come at a cost for the country, most notably for the estimated 4 million Americans left uninsured because they live in GOP-led states that have yet to expand Medicaid. The second lesson is that special interests pose a continued obstacle to change.
We worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured. Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits. But we also need to reinforce the sense of mission in health care that brought us an affordable polio vaccine and widely available penicillin.
The third lesson is the importance of pragmatism in both legislation and implementation. Simpler approaches to addressing our health care problems exist at both ends of the political spectrum: Yet the nation typically reaches its greatest heights when we find common ground between the public and private good and adjust along the way.
That was my approach with the ACA. We engaged with Congress to identify the combination of proven health reform ideas that could pass and have continued to adapt them since. This includes abandoning parts that do not work, like the voluntary long-term care program included in the law. It also means shutting down and restarting a process when it fails.
Both the process and the website were successful, and we created a playbook we are applying to technology projects across the government. I often think of a letter I received from Brent Brown of Wisconsin. We can help them. I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere.
As this progress with health care reform in the United States demonstrates, faith in responsibility, belief in opportunity, and ability to unite around common values are what makes this nation great. Conflict of Interest Disclosures: All of the individuals who assisted with the preparation of the manuscript are employed by the Executive Office of the President. National Center for Biotechnology Information , U. Published online Jul Barack Obama , JD.
Author information Copyright and License information Disclaimer. Copyright American Medical Association. This article has been cited by other articles in PMC. Impetus for Health Reform In my first days in office, I confronted an array of immediate challenges associated with the Great Recession. Open in a separate window. Percentage of Individuals in the United States Without Health Insurance, — Data are derived from the National Health Interview Survey and, for years prior to , supplementary information from other survey sources and administrative records.
Building on Progress to Date I am proud of the policy changes in the ACA and the progress that has been made toward a more affordable, high-quality, and accessible health care system. Published December 3, Accessed June 14, Health spending in OECD countries: Health Aff Millwood ; 27 6: The implications of regional variations in Medicare spending: The quality of health care delivered to adults in the United States.
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Do more health insurance options lead to higher wages? Published March 15, Accessed June 20, Centers for Disease Control and Prevention Trends in the prevalence of tobacco use: Updated June 9, Health Aff Millwood ; 29 6: Health insurance coverage and the Affordable Care Act, — Published March 3, Arkansas, Kentucky set pace in reducing uninsured rate. Published February 4, Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act.
Access to care and affordability have improved following Affordable Care Act implementation; problems remain. Health Aff Millwood ; 35 1: Is health insurance good for your financial health? Federal Reserve Bank of New York. Published June 6, The Affordable Care Act and the labor market: Office of the Assistant Secretary for Planning and Evaluation.
Published December 16, The Affordable Care Act: Published June 14, Accessed June 18, Published September 22, Published February 8, Contrary to cost-shift theory, lower Medicare hospital payment rates for inpatient care lead to lower private payment rates. Health Aff Millwood ; 32 5: Clemens J, Gottlieb JD. In the shadow of a giant: Accessed June 29, Growth and dispersion of accountable care organizations in Bureau of Economic Analysis Table 1. Price indexes for gross domestic product.
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United States Health Care Reform Progress to Date and Next Steps
Getting more health from healthcare: quality improvement must acknowledge patient coproduction—an essay by Paul Batalden. BMJ ; 3. Health care systems: getting more value for money. The OECD has assembled new comparative data on health policies and health care system efficiency for. The Mercatus Center at George Mason University reviewed 20 academic studies spanning 40 years and concluded: CON laws restrict competition in healthcare.