The Access to Care Report/This Week (#1): How Health Needs Are Measured Makes a Difference — In Legal Practice

July 11, 2013

health-care-lawThis is #1 in a series of weekly Access to Care Reports. 

There is current debate over how population health should be measured. (See for example Karen Hacker and Deborah Klein Walker, “Achieving population health in Accountable Care Organizations”, American Journal of Public Health, July, 2013.)

Legal advice given by attorneys depends on how health status is measured. Health care needs may be defined in a variety of ways, and strategies for access to care depend on how the problem is defined.

As proposed here, health status may be defined in terms of input measures, medical measures, or wellness measures. Each approach leads to its own strategies for representation.

Input measures address consumption of health care. More consumption is assumed to be “better”—examples are more provider visits or more prescriptions. This approach to measuring access risks being misdirected so that underlying needs may be missed.

Medical measures assume that access to medical care is key, and that success is often measured by reduced morbidity (sickness) and mortality (death) rates. The objective is  improved access to medical diagnosis and treatment (for example, dealing with high blood pressure and heart disease). This approach may miss some aspects of the bigger picture.

Wellness measures address lifestyle risk factors (such as smoking, obesity, and drug abuse). The objective is improved access to lifestyle improvements; a primary difficulty may be dealing with these factors in realistic community settings.

When adopting input measures, attorneys can help arrange for improved client consumption of treatments, perhaps through better family support or care management.

When dealing with medical measures, attorney emphasis can be on how to best obtain access to medical care, which often involves eligibility for programs.

And when dealing with wellness measures, attorneys can focus on lifestyle needs and community resources, based on a much broader perspective.

Legal advice given to clients related to access to health care will depend on the perspective being applied. Consideration of different measures, and evaluation of contrasting strategies, may be a useful practice approach.