Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators.

This useful volume defines a set of national objectives and identifies indicators--measures of utilization and outcome--that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location.

The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring.

This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.

Contents

• Committee on Monitoring Access to Personal Health Care Services
• Summary
  • General Conclusions on the State of Access
  • Defining Access
  • The Committee's Indicators and Progress Toward Access Objectives
  • Recommendations
• 1. Introduction
  • Background
  • Developing a Set of Indicators
  • Relationship of Access Monitoring to Other Relevant Activities
  • Major Data Sources: Their Uses and Limitations
  • Crosscutting Issues
  • References
• 2. A Model for Monitoring Access
  • Defining Access
  • Measuring Access
  • References
• 3. Using Indicators to Monitor National Objectives for Health Care
  • Objective 1: Promoting Successful Birth Outcomes
  • Objective 2: Reducing the Incidence of Vaccine-Preventable Childhood Diseases
  • Objective 3: Early Detection and Diagnosis of Treatable Diseases
  • Objective 4: Reducing the Effects of Chronic Diseases and Prolonging Life
  • Objective 5: Reducing Morbidity and Pain through Timely and Appropriate Treatment
  • References
• 4. Future Indicators
  • Access to Health Care for People with Disabilities
  • Family Violence
  • Emergency Services
  • Post-Acute-Care Services for the Elderly
  • Prescription Drugs
  • References
• 5. Recommendations
  • Recommendations
  • Future Steps
  • Reference
• Appendixes
  • A Developing Indicators of Access to Care: The Case for HIV Disease
  • B Developing Indicators of Access to Care: Waiting Lists for Drug Abuse Treatment
  • C Developing Indicators of Access to Care: The Case for Migrants and the Homeless
  • D "Ambulatory-Care-Sensitive" Conditions and "Referral-Sensitive" Surgeries

This project was supported by the Kellogg Endowment Fund, the Johnson & Johnson Foundation, the Baxter Foundation, the Robert Wood Johnson Foundation (Grant #18455), the Health Care Services Administration (Contract #75-05-0080), Department of Health and Human Services, and Institute of Medicine internal funds.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education.