November 29, 2013
“Access to care” is a complex concept. The appropriateness of the access to care that is made available can be a major issue.
It may be argued that access is flawed if care does not meet the needs of an individual in the most effective way.
Access depends on a patient-provider pairing, and many types of access may result.
One type of access depends on an external matching of “evaluated needs” with “appropriate services”. However, disagreements can arise as to how the assessment of needs is to take place, and how appropriate services are to be determined.
The generally-accepted opinions of licensed medical professionals are often used to select needs and services, and such decisions are taken to be objectively most appropriate.
However, access may be viewed very differently if an individual wishes to self-determine “needs” and to select the services that are desired.
Subjective access can depend on a matching of individual preferences with desired services, which may vary from medically-based procedures.
A preferred situation may result when objective and subjective decisions regarding access are the same. If they are different, an individual may choose to reject access that has been made available, and seek alternative care, or may be uncooperative with respect to arrangements.
However, matching objective and subjective access is often difficult with respect to care for chronic conditions.
An individual may not want to receive the type of care that is being made available, and those paying for care may refuse to consider other options.
Individuals often want care that will maximize their independence and result in the fewest restrictions. On the other hand, providers often prefer care that follows generally-accepted protocols and arrangements.
The result may sometimes be care that fails both objective and subjective access tests, and maximizes costs.
The “Health Home” (HH) concept included as section 2703 of the Affordable Care Act (ACA) is intended to explore ways in which to better align objective and subjective approaches to providing chronic care.
Care coordinators are to be authorized to improve total access to care for services, with full agreement from the patient as to the strategies being applied.
If this approach to chronic care can be shown to work, it may be possible to combine better care—that is more satisfactory to patients—with reduced care costs.
A general introduction to the HH program is provided in another posting this week—on this legal solutions blog—as Obamacare Report #21. An additional posting this week also describes how the State of Washington is implementing an HH program (see Washington Elder Law Practice Report #4).
More on related ACA and access-to-care topics, with wide-ranging discussions of funding sources for care, may be found in a recent book by the authors that describes implementation of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.