Healthy People Consortium Meeting
"Implementing Healthy People 2010"
November 11, 2000

Summary of Breakout Group Discussion Concerning:
Access to Quality Health Services

This focus area of Healthy People is very broad. Expressed hope that those in the room reflected a broad audience (show of hands indicated that 25 percent were primary care related, 20 percent EMS and LTC, and the rest varied).

Covered Access Objectives

Issues Related to Prevention

Focus on broad, cross-cutting issues (presented overheads of objectives 1-1, 1-2, 1-3). Spoke briefly about these objectives and referenced studies about them.

AHRQ is putting together a companion document on clinical preventative services so that it will be more useful to doctors.

1. Healthy People 2010: there are 67 objectives relating to clinical preventive services.

2. U.S. Preventive Services Task Force: has developed a national guideline clearinghouse (www.guideline.gov).

3. Clinical Preventive Services:

• Put prevention into practice.
• CDC has a task force on CPS.
• Mentioned utilization of HEDIS measures. 

4. Assess receipt of CPS

• Compilation of relevant databases.
• Summarize disparities (geographic, racial, gender, orientation, etc.).
• Benchmarking (by State Healthy People plans).

EMS

Why is EMS a part of public health? Because EMS deals with entire continuum of "the big H" health, from preventive services to clinical practice.

• Covered all EMS objectives in Healthy People 2010: covering objectives 1-10 through a question on NHIS.
• Mentioned that Illinois Department of Health worked with a wide range of groups to deal with local EMS issues.

What to measure when implementing Healthy People 2010?

• This only addresses medical care, not HEALTH care; measure needs to be access to all health services, not just medicine.
• There is a big need for the full health practitioner position.
• Most preventive services are NOT covered by health plans; what about COA, Medicaid measure (quismic) not listed; include more accrediting agencies.
• Need to deal with health agencies that are private.
• Public Health Foundation is writing a companion document with BHP (HRSA) about workforce.
• Wants to see cultural competence issues dealt with more broadly than race and ethnicity (to include gender, geography, etc.).
• Need to consider access barriers based on linguistics.
• Can't focus on just race and ethnicity (vis-à-vis Appalachia).
• Can't slice the problem as urban vs. rural from disease processes; too complex.
• State of Iowa is working with transportation folks in the State; more of these partnerships are needed to address Access issues.
• Someone pointed out that NHTSA (in DOT) is launching an effort regarding its role in public health.
• Requesting cultural competence is not possible, in someone's view.
• Feds need to deal with Institute of Medicine's social determinants of health report; should look at multiple targets together.
• Why Puerto Rico, Islands, etc., omitted from objective?
• Ought to collect a list of all Healthy People companion documents in one place.
• There is no benchmark for how long it takes someone to get into the care system from the time they first go to apply. The system will continue to fail if we don't set standards for a reasonable amount of time for a clinic to first see a patient.
• The issue was raised about the changing definition of minority and how these changes affect funding streams.
• States and localities need instruments that are already tested and valid to use to collect their data.

Working With Community Groups

• Need to think about roles and responsibilities and acting at local level.
• NALBOH president mentioned that it is working to increase awareness of local public health issues.
• "Part of what we need to do is show the connections of public health to other topics."
• HRSA is open to community telling the agency what needs to be done.
• In Arizona there is a focus on qualitative data issues because they have seen that access is not just a coverage issue; many people with coverage are still not getting care and so need to ask "why."
• There is a serious need to develop measures and strategies for local data collection.

Barriers to Implementation

• The HCFA Web site has information about emerging transportation issues.
• The public needs to be educated about the issues around gaps and needs.
• Strong complaint about the role of the Federal government in regulations about Medicaid coverage.
• There is a need to get information out in creative ways to various populations.
• Lack of capacity in public health infrastructure is a big problem.
• Need help from Feds on "inaudible."
• Need to be sure to get community input on policy issues.
• Another reference to data analysis issues (plenty of data in some areas, but no one to analyze).
• Need to deal with level of information put out in media (i.e., making sure the message meets the audience wherever that audience is).

Back to Consortium 2000 Table of Contents