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Access to health care.

Along with quality and cost, access to health care is one of the three major concerns spurring an overhaul of the nation's health care system. Those concerned about access typically cite the number of Americans who lack health insurance, but this statistic does not tell us what we really need to know: How many Americans are not receiving timely and necessary medical care?

To help remedy this situation, an Institute of Medicine committee recently developed a set of 15 "indicators" of access. These include traditional measures such as the number of uninsured and infant mortality rates, but also new yardsticks, including the incidence of vaccine-preventable childhood diseases, screening rates for early detection of breast and cervical cancers, and avoidable hospitalization for chronic diseases and acute medical conditions.

The committee sought indicators that would reveal not only how well society as a whole is doing but to what extent the uninsured, minorities, and the poor are at a particular disadvantage. The results point to a continuing and striking gap in access to health care between the haves and have-nots. Also unsettling, the committee said, is that little progress in access has been made in the past decade.

The committee recommended that a federal organization be made responsible for monitoring access to health care services, including collecting, analyzing, improving, and disseminating information about changes in access. More research is also needed on the factors that affect access. "Even if the United States were to adopt universal entitlement," the committee said, "achieving the objectives around which its indicators are organized is likely to remain a great challenge."
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Publication:Issues in Science and Technology
Date:Jun 22, 1993
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