Academic journal article Health Care Financing Review


Academic journal article Health Care Financing Review


Article excerpt


Access to health services for vulnerable populations is the primary focus of the articles in this issue of the Health Care Financing Review. There are two critical elements which need to be explored. The first is how one defines access to health care. Access has been defined as "...those dimensions which describe the potential and actual entry of a given population group to the health care delivery system" (Aday, Fleming, and Andersen, 1984). Measures of access reflect, therefore, whether persons who need care are able to obtain it (Health Care Financing Administration, 1994).

The second critical element is how one defines a vulnerable population. Vulnerable population subgroups are those individuals with characteristics that put them at risk for not receiving needed care (Health Care Financing Administration, 1994). Examples of groups that have been identified by the Health Care Financing Administration (HCFA) include minorities, the frail elderly, persons in poor health, low-income per sons, high-risk pregnant women and their infants and children, underserved individuals, and the disabled. Some individuals, such as the low-income frail elderly, are particularly vulnerable since they possess multiple characteristics which put them at risk.

This article presents an overview of the topics presented in this issue of the Health Care Financing Review. As can be seen from the variety of articles, vulnerable popula-tions can be defined in many ways. Health status, race and ethnicity, and socioeconomic status are a few of the approaches used in these articles to identify vulnerable populations. Persons in poor health are vulnerable in that they require more frequent contact with the health care delivery system. Additionally, it is widely recognized that race and socioeconomic status are associated with health status and access (Nickers, 1995; Schulman et al., 1995; Ford and Cooper, 1995). For example, black persons and persons in lower socioeconomic groups have higher mortality rates.

For the ease of discussion, the majority of the articles in this issue of the Health Care Financing Review can be categorized into six domains. The first five categories address access issues for specific vulnerable populations: Medicaid and pregnant women, access measures by health status, use rates for racial and ethnic minorities, access for ESRD patients, and access for additional special populations. In the sixth category, the impact of physician payment reform on access is examined. Finally, an examination of Medicare spending is presented. Per capita expenditures is a particularly useful measure to use in access-studies which make comparisons between groups. The author is with the HCFA Office of Research and Demonstrations the opinions expressed are those of the author and do not necessarily reflect those of HCFA.


The article by Ellwood and Kenney focuses on the effect of the Medicaid expansions for pregnant women in California, Georgia, Michigan, and Tennessee. Prior to the Medicaid expansions for pregnant women in the late 1980s, eligibility was linked to receiving Aid to Families with Dependent Children (AFDC). The income standards associated with AFDC are typically lower than the Federal poverty level. The intent of the Medicaid expansions for pregnant women was to enroll more low-income pregnant women and thereby improve access to prenatal care and birth outcomes. This study reveals some mixed results. Results show that the number of births financed by Medicaid substantially increased, but early enrollment of pregnant women who are new to Medicaid continues to be a problem.


Survey data contain measures of health status which cannot be obtained from claims data. Health status measures available from surveys, such as self-reported health status and activity limitations, add a unique perspective to the study of access. …

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