Index

A

Access, definition of, 4-5, 32-34

Acute conditions

avoidable hospitalization for, 14, 121-124, 144

of homeless, 210

of migrant workers, 204-206

physician contacts for, 14, 112-115, 144

Admissions, see Hospitalization

Aerosolized pentamidine, 164

African Americans, see Black

population

Aged persons, see Older population

AIDS, see HIV infection

Ambulatory care

for acute conditions, 112-115

and avoidable hospitalization, 12-14, 102-105, 121-124, 143, 219-221

for HIV patients, 155-156, 159-161

Assistance programs, 42

for migrant and homeless populations, 200-201

for vaccination, 73

see also Integration of services;

Medicaid;

Medicare;

WIC

Asthma, 106

AZT, 164-165

B

Barriers to access, 20, 31-32, 39, 44

for HIV patients, 150-169

for migrants and homeless, 207-208, 211-212

see also Cultural factors;

Financial factors;

Structural Factors

Battered women, 133-134

Behavioral Risk Factor Surveillance System (BRFSS), 79, 86

Birth certificates, 25, 51, 54-55, 62

and infant mortality, 56, 59-60, 140

Births and birth outcomes, 5

see also Birth certificates;

Birthweight;

Congenital syphilis;

Infant mortality;

Prenatal care

Birthweight, 3, 5, 61-66, 141

among homeless, 210

Black population, 3, 17, 41, 105, 139



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Access to Health Care in America Index A Access, definition of, 4-5, 32-34 Acute conditions avoidable hospitalization for, 14, 121-124, 144 of homeless, 210 of migrant workers, 204-206 physician contacts for, 14, 112-115, 144 Admissions, see Hospitalization Aerosolized pentamidine, 164 African Americans, see Black population Aged persons, see Older population AIDS, see HIV infection Ambulatory care for acute conditions, 112-115 and avoidable hospitalization, 12-14, 102-105, 121-124, 143, 219-221 for HIV patients, 155-156, 159-161 Assistance programs, 42 for migrant and homeless populations, 200-201 for vaccination, 73 see also Integration of services; Medicaid; Medicare; WIC Asthma, 106 AZT, 164-165 B Barriers to access, 20, 31-32, 39, 44 for HIV patients, 150-169 for migrants and homeless, 207-208, 211-212 see also Cultural factors; Financial factors; Structural Factors Battered women, 133-134 Behavioral Risk Factor Surveillance System (BRFSS), 79, 86 Birth certificates, 25, 51, 54-55, 62 and infant mortality, 56, 59-60, 140 Births and birth outcomes, 5 see also Birth certificates; Birthweight; Congenital syphilis; Infant mortality; Prenatal care Birthweight, 3, 5, 61-66, 141 among homeless, 210 Black population, 3, 17, 41, 105, 139

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Access to Health Care in America birthweight, 62-65, 141 cancer and cancer screening, 80-81, 87-89, 91, 143 congenital syphilis, 67-69, 141 dental care, 118, 119 excess deaths, 106-109 infant mortality, 58-60, 61, 140 physician contacts, 113-114 prenatal care, 5, 52-54 referral-sensitive procedures, 99, 101-102 Breast cancer, 86-89, 142-143 screening, 8-11, 79-84 Bureau of Health Care Delivery and Assistance, 214 Bureau of Maternal and Child Health, 56 C Cancer breast, 8-11, 79-84, 86-89, 142-143 cervical, 8-9, 11, 79-80, 84-87, 89-90, 142-143 lung, 99 registries, 27, 87, 91, 142-143 screening, 8-11, 79-86 Case management, 40, 101 Cervical cancer, 86-87, 89-90, 142-143 screening, 8-9, 11, 79-80, 84-86 Children abuse of, 133 chronic diseases, 95 dental condition, 118 homeless and migrant, 204-205, 212 physician contacts, 115 well-child care, 56, 74 see also Infant mortality; Vaccination Chronic diseases, 11-14, 112, 143-144 among homeless, 210 among migrant workers, 206 avoidable hospitalization, 102-106, 143 continuing care, 91-98 discretionary care, 98-102, 143 excess deaths, 106-112, 144 Claims data, 28 Cocaine, and congenital syphilis, 6, 69, 141 Compliance with treatment, 38 Congenital syphilis, 5-6, 66-69, 141 Cultural factors, 42-43 and birthweight, 65-66, 141 Current Population Survey, 41 D Data bases, 22, 23-25, 28, 29, 102 on birthweight, 65, 141 see also Discharge records; Disease reporting and registries; Surveys; Vital statistics Death certificates, 25 HIV data, 174-175 and infant mortality, 56, 59-61 Deaths among homeless, 210-211 excess, 106-112, 144 Dental services, 14-15, 115-120, 144 for HIV patients, 164 Department of Health and Human Services, 139 Diabetes, 91-92, 96-97, 106, 205 Disabled population, 132-133 Discharge records, 27, 102, 103, 106, 143 for HIV patients, 171-172, 174 for migrant and homeless population, 215 Discretionary care, 98-102, 143 Disease reporting and registries, 28 cancer, 27, 87, 91, 142-143 congenital syphilis, 66-67 HIV, 171, 174 vaccine-preventable disease, 75-76, 78, 142 Domestic violence, 133-134 Drug abuse, 131 among HIV patients, 160 and congenital syphilis, 6, 69, 141 and hospitalization, 105-106 treatment waiting lists, 181-197 Drugs, prescription, 135-136 for HIV treatment, 172-173

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Access to Health Care in America E Early detection, see Screening and testing Early Periodic Screening, Diagnosis, and Treatment program, 74 "Ecological fallacy," 27 Elderly, see Older population Emergency care, 121-122, 123, 134 for battered women, 133 as primary provider, 40 Employer-provided insurance, 41, 151 End-stage renal disease, 99 Equity of access, issues, 3, 4, 17-18, 31-33 Ethnic groups, see Black population; Cultural factors; Hispanic population; Racial and ethnic groups F Family planning services, 50 Family violence, 133-134 Federal Interagency Committee on Migrants, 214-215 Federal monitoring role, 16, 29, 138-139 prenatal care, 56, 140 Financial factors, 40-42 dental care, 15, 116, 119 for disabled, 132 HIV treatment, 150-159 Pap tests, 85 prenatal care, 56, 140 vaccination, 73-74 see also Insurance and insurance coverage; Poverty and low-income; Uninsured and underinsured population Frequency of services use, 36 G Geographic factors and analyses, 3, 14, 27, 40 chronic diseases, 93, 95 for HIV patients, 162, 174 hospitalization, 103-104 prenatal care, 56 vaccination, 71 H Health Care for the Homeless programs, 209-210, 211, 213-214, 215 Health Objectives for the Year 2000, 23 birthweight, 63-64 cancer and cancer screening, 83, 85 congenital syphilis, 69 domestic violence, 133 infant mortality, 60 preventable disease, 78 vaccination, 73 Healthy People 2000, 23, 133 "Herd immunity," 76 Hip replacements, 98 Hispanic population, 41 birthweight, 62-63, 65 cancer and cancer screening, 80-82, 84-85 dental condition, 118 infant mortality, 60, 61, 141 measles, 78 physician contacts, 113-115 HIV infection, 147-175 among migrant workers, 206 Home health services, 134-135 for HIV patients, 157, 169, 173-175 Homeless population, 199-202, 209-216 Hospices, HIV patient care, 157-158 Hospitalization, 3, 14 avoidable, 12-14, 102-106, 121-124, 143, 144 for dental conditions, 199-120 of HIV patients, 153, 155, 158-159, 168-169, 171, 173-175 Human immunodeficiency virus, see HIV infection I Immunization, see Vaccination Income levels, see Financial factors; Poverty and low-income

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Access to Health Care in America Indicators of access, 1-2, 4-5, 34-36, 46-49, 130-131 development of, 20, 21-22 see also Outcome indicators; Utilization indicators Infant mortality, 3, 5, 56-61, 140-141 among migrant and homeless populations, 204, 210, 216 Insurance and insurance coverage, 3, 14, 17, 19-20, 26, 27, 28, 41 and birthweight, 65 chronic diseases, 93-95, 97 dental services, 15, 116, 118-120 disabled persons, 132 HIV patients, 150-154 prescription drugs, 135 referral-sensitive procedures, 101 vaccination, 73-74 see also Medicaid; Medicare; Uninsured and underinsured population Integration of services, 18, 122 for battered women, 133-134 for disabled, 132-133 International Classification of Diseases, 61, 103 K Kessner index, 52, 53 L Language barriers, 42, 200 Late-stage cancer, 10-11, 86-91, 142-143 Local-level monitoring, 16-17, 137-138 tumor registries, 27 Longitudinal surveys, on chronic diseases, 96-97, 143 Long-term care, 134-135 Low birthweight, 3, 5, 61-66, 141 among homeless, 210 Low-income, see Poverty and low-income Lung cancer, 99 M Mammography, 9-10, 81-84 Measles, 76-78 Medicaid, 40 and chronic diseases, 94-96 dental coverage, 120 HIV patient coverage, 153-158 migrant and homeless coverage, 207-208, 215 vaccination coverage, 74 Medi-Cal, dental coverage, 120 Medicare, 42 and chronic diseases, 93-96 end-stage renal disease program, 99 and referral-sensitive procedures, 102 Migrant farmworkers, 199-209, 212-216 Minority groups, see Black population; Cultural factors; Hispanic population; Racial and ethnic groups Models and modeling, 36, 110-112 N National Center for Health Statistics (NCHS), 55, 65 National Fetal and Infant Mortality Review Program, 56 National Health and Nutrition Examination Survey, 96 National Health Interview Survey (NHIS), 25-26, 41 cancer screening data, 79-80, 86 chronic disease data, 92-93, 98, 143, 144 dental care data, 116, 120, 144 disability care data, 133 physician contact data, 115 vaccination data, 142 National Maternal and Infant Health Survey (NMIHS), 55, 62, 140, 141 National Medical Expenditure Survey (NMES), 26, 41 National Mortality Followback Survey, 111

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Access to Health Care in America Neonatal intensive care units (NICUs), 57 New York drug treatment programs, 183, 188-189 HIV patient services, 157, 160 Statewide Planning and Research Cooperative System (SPARCS), 172 Notifiable diseases, see Disease reporting and registries Nurses, HIV patient contacts, 168 Nursing homes, HIV patient care, 156-157, 169 Nutrition services, and prenatal care, 50-51 O Older population, 42 cancer screening, 9, 80-82, 84, 85 dental care, 118 postacute services, 134-135 Outcome indicators, 33-34, 37-38, 131 avoidable hospitalizations, 12-14, 102-106, 121-124, 144 breast cancer, 86-89, 142-143 cervical cancer, 86-87, 89-90, 142-143 chronic diseases, 102-112, 143-144 congenital syphilis, 5-6, 66-69, 141 for HIV patients, 170-175 passim infant mortality, 56-61, 140-141 low birthweight, 61-66, 141 vaccine-preventable diseases, 75-78, 142 Outpatient care, see Ambulatory care; Physicians P Pap tests, 9, 84-86, 89 Payment sources, on vital statistics records, 60, 62 see also Insurance and insurance coverage; Medicaid; Medicare Perinatal care, 56 Physicians, 112-115, 144 disease reporting, 28, 78 HIV patient contacts, 156, 161-162, 163-164, 167 and hospital admissions, 104, 124 migrant worker contacts, 208 and Pap tests, 85-86 Planned pregnancies, 50 Pneumocystis carinii pneumonia, 174 Population groups, see Black population; Cultural factors; Disabled population; Hispanic population; Homeless population; Migrant farmworkers; Older population; Poverty and low-income; Racial and ethnic groups Poverty and low-income, 3, 40-41 cancer and cancer screening, 83, 85, 87, 88-89 dental care, 116 emergency care, 134 hospitalization, 14, 104-106, 122-124 physician contacts, 115 prenatal care, 51, 140 referral-sensitive procedures, 11-12, 99-101 vaccination, 73-74 Preconception medical care, 50 Prenatal care, 2, 5, 18, 25, 49-56, 140 among homeless, 212 and congenital syphilis, 69 and low birthweight, 61 Preschool immunization, 69-75, 141-142 Prescription drugs, 135-136 President's Commission for the Study of Ethical Problems in Medicine and Biomedicine and Behavioral Science Research, 32-33 Providers of care, 36 for HIV patients, 155-164, 166-169 for migrants and homeless, 208, 211-212 Pap tests, 85 see also Physicians Public Health Service, 141

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Access to Health Care in America Expert Panel on the Content of Prenatal Care, 49-50 Q Quality of care, issues, 37-38 R Racial and ethnic groups, 3, 11, 17, 28-29, 41, 139 birthweight, 62-65, 141 cancer and cancer screening, 9, 11, 80-82, 84-85, 87-89 childhood diseases, 78 chronic diseases, 96, 144 congenital syphilis, 67-69 dental care, 15 infant mortality, 3, 69-61, 140 prenatal care, 5, 52-54, 55 vaccination, 71, 72 see also Black population; Cultural factors; Hispanic population Referral-sensitive procedures, 11-12, 98-102, 143, 221 Regular sources of care, 114-115 for HIV patients, 159-162 Reports and reporting, see Disease reporting and registries; School-based reporting systems; Self-reported health status; Surveys Research needs, 17, 29 birth outcomes, 54-56, 60-61, 65-66, 69, 140-141 cancer and cancer screening, 86, 91, 142-143 chronic diseases, 96-98, 100-101, 102, 104, 106, 110-112, 143-144 dental care, 120, 144 drug abuse treatment, 195-196 HIV treatment, 169-175 hospitalization, 104, 106, 123-124, 143, 144 migrant and homeless population, 209, 212-216 minority groups, 17, 29, 139 vaccination, 74-75, 78, 141-142 Risk factors, data collection and analysis, 57, 79, 86, 107-112 see also Drug abuse Robert Wood Johnson Foundation, AIDS Health Services Programs, 149 -150 Routine care, 114-115 S School-based reporting systems, for vaccination, 74-75, 141-142 Screening and testing, 8-11 cancer, 8-11, 79-86 for HIV, 170-171 Self-reported health status, 11, 25, 92-93 Sentinel diseases, 37 Social indicators, 34, 36 Social services, see Integration of services Special Supplemental Food Program for Women, Infants, and Children , 50-51 State-level monitoring, 16-17, 137-138 hospital discharge data, 106, 143 migrant and homeless populations, 216 prenatal care, 56, 140 tumor registries, 27, 87, 142-143 Statistical programs, see Data bases; Research needs; Surveys Structural factors, 39-40 in HIV treatment, 159-164 in migrant and homeless care, 215 Substance abuse, see Drug abuse Surgical procedures, discretionary, 98-102, 143 Surveillance, Epidemiology, and End Results (SEER) program, 87, 91 , 142-143 Surveillance programs, see Disease reporting and registries Surveys, 25-26 cancer screening, 79-80, 86 chronic diseases, 96-98, 144 drug abuse treatment, 196

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Access to Health Care in America excess mortality studies, 111-112 migrant and homeless populations, 199, 200, 212, 213-214, 215-216 oversampling of minorities, 17, 29, 139 vaccination, 70, 74, 142 see also National Health Interview Survey; National Maternal and Infant Health Survey; National Medical Expenditure Survey Syphilis, see Congenital syphilis T Testing, see Screening and testing Timeliness of treatment, 4, 14-15, 112-115, 144 for drug abuse, 181-197 for migrant workers, 208-209 Transplants, 99 Tumor registries, 27, 87, 91, 142-143 U Uninsured and underinsured population, 3, 14, 28, 41-42 chronic diseases, 93-96 dental care, 116, 118-119 physician contacts, 113-115 referral-sensitive procedures, 99 Unwanted pregnancies, 50 Utilization indicators, 34, 36-37, 131 cancer screening, 8-11, 79-86 chronic diseases, 91-102, 143 dental services, 115-120, 144 frequency, 36 for HIV patients, 170-175 passim for migrant and homeless populations, 212-216 physician contacts, 112-115, 144 prenatal care, 49-56, 140 vaccination, 69-75, 141-142 V Vaccination, 7-8, 69-75, 141-142 preventable diseases, 75-78, 142 Violence, domestic, 133-134 Vital statistics, 25 on migrant and homeless populations, 204, 210-211, 214-215 see also Birth certificates; Death certificates W Waiting lists and times for drug abuse treatment, 191-197 for HIV patients, 162-163 Well-child care, 56, 74 WIC, 50-51 Women, see Battered women; Breast cancer; Cervical cancer; Prenatal care World Health Organization, Health for All Project, 23 Y Year 2000 Health Objectives for the Nation, see Health Objectives for the Year 2000 Z Zidovudine, 164-165 Zip codes, use in analysis, 3, 14, 27, 103-104

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