Policy and Position Statements

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Access to Health Services Policy Statement

State and territorial health agencies improve the health of the population by ensuring access to the health services necessary to protect and improve the health of individuals and improve health outcomes of communities and populations. They do this by: supporting healthy environments and communities, implementing effective interventions to support positive health behaviors, and supporting effective clinical preventive services throughout the life course. This is accomplished by providing leadership, policy development, and core public health services that lead to better care for individuals, lowered costs for healthcare, and better health for everyone.

ASTHO recognizes that while access to care is critically important, there are a number of factors beyond traditional health services that impact health outcomes and lead to health inequities. While this statement touches on some strategies for addressing the social determinants of health, working across sectors, and achieving optimal health for all, it is meant to complement ASTHO’s Achieving Optimal Health for All policy statement, Health in All Policies position statement, and Public Health Workforce position statement.

Principles for Healthcare Access:

Healthy People 2020 cites healthcare access as an important factor in preventing disease and disability, detecting and treating illnesses, increasing quality of life, reducing the likelihood of premature death, and increasing life expectancy, yet one in four Americans lacks a primary care provider or health center where they can receive regular medical care.1 In order to improve health, ASTHO supports strategies that increase access to high quality health services, as well as access to the conditions necessary for achieving optimal health.

ASTHO supports policies, interventions, and strategies to ensure that all Americans have access to:

  • Primary care and preventive services, including behavioral health (i.e., mental health and substance abuse) and oral health.
  • Maternal and child health services, including family planning, prenatal, and perinatal care.
  • Specialty, tertiary, and emergency health services, when necessary and clinically appropriate.
  • Health services that are comprehensive, coordinated, patient-centered, and prevention-focused.
  • Health services that are culturally and linguistically appropriate.
  • Health services in community-based settings close to the individuals and families receiving services.
  • Health services that are tailored to the particular needs of each community.
  • Insurance coverage that minimizes financial barriers to the timely use of necessary health services.
  • Community and social services that address the social determinants of health.

Strategies for Promoting Healthcare Access:

To accomplish these goals, ASTHO encourages state and territorial health agencies to:

1.  Ensure access to high quality, prevention focused primary care: Primary care and clinical and community preventive services help expand quality and years of life and help individuals learn, live, work, and play at their highest levels of health and productivity.2 Those with access to primary and preventive health services are more likely to receive health screenings, seek and receive care from appropriate sources when they become ill, and receive ongoing support for management of chronic conditions.3 ASTHO supports:

  • Collecting data to provide accurate and up-to-date assessments of the population’s access to primary care services, including behavioral health (i.e., mental health and substance abuse treatment services) and oral health.
  • Funding and promoting Federal and state programs that aim to increase access to primary care and encourage healthcare providers to practice in rural and underserved areas. 
  • Collaborating with federal, state, territorial, tribal, and local partners to successfully implement strategies that lead to improved primary care access.
  • Supporting a strong health services safety net including a system of hospitals, community health centers and other primary care safety net providers, school-based clinics, and state and local health departments.
  • Providing tools and technical assistance to enable healthcare providers to incorporate evidence-based clinical and community based preventive services into practice and to integrate and coordinate public health and healthcare services.4  

2.  Develop and support policies, focused interventions, and programs designed to advance health equity and enable all people to attain their highest possible level of health: Policies and programs should be targeted and culturally appropriate to support vulnerable populations that have special health needs, may be at particular risk for adverse health outcomes, or experience disparities or other experiences that interfere with achieving optimal health. ASTHO supports:

  • Collaborating with federal, tribal, and local partners to develop and support policies, focused interventions, and programs designed to eliminate or reduce health inequities and enable all people to attain their highest possible level of health.
  • Collaborating with Medicaid to support policies, focused interventions, and programs to increase access to health services for low-income populations.
  • Forming partnerships to ensure that health services are culturally and linguistically appropriate.
  • Ensuring health services address critical public health challenges faced by vulnerable populations, including tuberculosis and other infectious diseases, sexually transmitted infections, family planning, and cancer screening and diagnosis.
  • Collecting and sharing data within and across departments to better understand and address health inequities and the connections between access to care and health outcomes.

3.  Focus on increasing access to programs and services that impact overall population health: Although having access to clinical care is critically important, 40 percent of health outcomes are determined by social and economic factors, such as the places where people live, work, learn, worship, and play.5 Access to healthier food, injury prevention efforts, safe and accessible places for physical activity, smoke-free environments, transportation, and the integration of community services with primary care are important components of achieving optimal health. In order to increase access to all of the conditions that create health, ASTHO supports:

  • Proactively forming partnerships with agencies and organizations in sectors beyond public health and clinical care to advance a "health in all policies" strategy to address the social determinants of health.
  • Promoting models of care that link clinical, community, and social services.

4.  Develop and support payment and delivery models that increase access to coordinated, team-based quality care: In the current healthcare landscape, there are unprecedented opportunities for states and territories to test different models of payment and care delivery. By working with payers to find new ways of financing innovative care delivery practices, state health agencies can help increase access to the high quality, prevention based, coordinated care necessary to improve population health. ASTHO supports:

  • Developing healthcare systems in which all individuals have a patient-centered medical home by which care is coordinated and individuals are linked to needed personal and community health services.
  • Reforming payment systems to focus on access, quality, care coordination, and performance (clinical and population health outcomes) instead of on the quantity of services delivered.

5.  Increase access to a variety of care delivery mechanisms, including new and emerging technologies: Increasingly, healthcare providers and the healthcare workforce population are finding new and innovative opportunities for delivering care outside of traditional clinical settings. These new delivery mechanisms are important for reaching vulnerable populations and improving access for traditionally underserved communities and people living in rural areas. ASTHO supports:

  • Leveraging advancements in telehealth and telemedicine including exploring licensing requirements and reimbursement policies to allow maximum use of telehealth.
  • Promoting the use of home visiting programs to improve the health outcomes of women, children, and families.
  • Exploring and promoting workforce initiatives that broaden the delivery system through the use of emerging and evolving health professions (e.g., community health workers, community paramedicine).

6.  Support linkages between clinical care and community services: Creating sustainable, effective linkages between healthcare, public health, and community resources and partners can improve patients' access to care and services and ultimately lead to better health outcomes.6 These linkages are particularly important when addressing the social determinants of health conditions. ASTHO supports:

  • Facilitating relationship‐building between state and local public health agencies, providers, and community organizations.
  • Including providers, public health, and community services in referral systems, care coordination, and team‐based care models.
  • Involving patients, families, and communities in strategic planning and improvement activities.

Conclusion:

Access to health services is a central component of improving the health of the population, but it is becoming increasingly clear that the social determinants of health also play a major role in health outcomes and public health must focus on increasing access to the conditions necessary for people to live healthier lives. In order to truly improve the health of the population, we must increase access to services that are high quality, coordinated, prevention based, and linked to the community and social services necessary to address the social determinants of health. There are unprecedented opportunities right now to change the way we understand, pay for, and deliver healthcare in the United States, and state health agencies must ensure they are using these opportunities to make certain all Americans have access to the services and conditions necessary to achieve optimal health.


Approval History:

Access Policy Committee Review and Approval: May 2, 2016
Board of Directors Review and Approval: June 28, 2016
Ratified by the ASTHO Assembly of Member: September 21, 2016
Policy expires: December 2019

ASTHO policies are broad statements of enduring principles related to particular policy areas that are used to guide ASTHO's actions and external communications.


Related ASTHO Documents:

Achieving Optimal Health for All Policy Statement
Prevention Policy Statement
Health in All Policies Position Statement
Public Health Workforce Position Statement


Notes:

  1. Office of Disease Prevention and Promotion, Healthy People 2020, Access to Health Services, Washington DC; 2016. Accessed at: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Access-to-Health-Services.
  2. National Prevention Council, National Prevention Strategy, Washington, D.C.: HHS, Office of the Surgeon General; 2011. Accessed at http://www.cdc.gov/Features/PreventionStrategy/.
  3. Agency for Healthcare Research and Quality. Chapter 9. Access to Health Care. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. Accessed at http://www.ahrq.gov/research/findings/nhqrdr/nhqr11/chap9.html.
  4. Guide to Community Preventive Services. CDC. Accessed at http://www.thecommunityguide.org.
  5. Kindig D, Asada Y, Booske B. A population health framework for setting national and state health goals. JAMA. 2008; 299(17): 2081-3.
  6. Clinical-Community Linkages. June 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/community/index.html.