Opportunities and Challenges

Opportunities and challenges continue to exist when examining the disparities in access to health care and the 45 million persons who are uninsured. The Institute of Medicine has estimated that 18,000 deaths per year are directly related to the lack of health care insurance.¹⁸

There is a continued need to focus efforts on geographic regions where persons have limited access to primary and preventive health care. These include, but are not restricted to, rural and border areas. Rural Healthy People 2010 and Healthy Border 2010, companion documents to Healthy People 2010, recognize significant preventable threats to health and identify priority health needs for residents of these regions.^{19, 20}

Recruitment, training, and continuing education of the Nation's health care workforce, focused on both sentinel components of disease prevention and chronic care management, will continue to be important as linguistically appropriate services are needed.

Challenges exist for meeting targets for long-term care (LTC) services of home health, adult day care, assisted living, and nursing home care. Few older and middle-aged adults purchase LTC insurance due to the general misconception that Medicare provides coverage for extended use of LTC services.²¹  Consumers have difficulty comparing one LTC policy with another because of differences in the services covered (for example, nursing home care versus home- and community-based care), as well as the extent and nature of the coverage.^{21, 22} Older adults prefer to receive LTC services at home or in the community, rather than give up their independence by moving to a nursing home.²³ These preferences result in a greater demand for home health care and more challenges in meeting the target. 

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