Access and Availability: Two Challenges for US Health Care
The United States (US) health care system is changing dramatically. The Affordable Care Act is a catalyst that is spurring change by the promotion of two drivers: access and primary preventative care. Before the passage of the Affordable Care Act (ACA) in 2010, over 47 million Americans were uninsured thus denying them access to basic health care (U.S. Department of Health and Human Services [HHS], 2012). Increasing access and increasing the availability of primary care services (pre-natal care, preventative care, primary disease prevention, and secondary disease prevention) can improve the overall health in the US.
Through increasing access the ACA has several challenges; (a) high cost may result in rationing; and (b) shortage of primary care providers (Shi & Singh, 2012). This shortage will have a greater effect on the South and Mountain West where primary care providers compose 57% of all physicians practicing in rural areas, and 81% of physicians in smaller rural counties, as compared with 38% in urban areas (American College of Physicians, 1995) (Shi & Singh, 2012). Currently, access to care and access to primary care providers remains a challenge for many Americans. The ACA does not go into full effect until 2014 (HHS, 2012). America remains the only country that discriminates against patients based on their ability to pay or their legal status (Neuberger, 2008).
Several lessons from around the world can help health care administrators in the US shape future policy to effectively manage access and improve availability of primary care providers. Cuba has a public health system that is decentralized and has adopted a community medicine model. This equates to community involvement and mobilization of a collective force to address collective needs (Bourne, Keck, &...