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Millions of Americans – and one in five Texans – have no health insurance. In the long term, the lack of preventive care leads to a much more expensive burden on society and insurers when care is delayed. Americans are more obese. They have more chronic conditions than ever, in spite of fitness centers and diets abounding. Technology is moving at warp speed to improve health care. Rural areas often have no health care providers. Paperwork to manage health care is expensive. And physicians are abandoning their practices, fed up with the bureaucratic nature of insurers and government.
The health care system in the United States is a patchwork quilt, mended together over time to address disparate needs. It is a mix of private interest and government involvement at the federal, state and local levels. Sounds like a mess for what is arguably the finest health care system in the world. But in none of our research do we find anyone arguing that health care (as we know it or envision it) can’t be better. What is missing is a shared vision of the desired future of our health care system and broad-based support for that vision. Change is critical and the time to create the environment for change is now.
That’s the purpose of this exercise: to encourage businesses to engage employees around the topic of what America’s health policy should be. The idea for this toolkit grew from several health care events sponsored by Texas Health Resources where business leaders engaged in a dialogue around a set of principles that might be incorporated into communication with legislative leaders on the subject of health care. If you’re listening, you know that affordable health care has emerged as one of the country’s leading concerns.
But how can America’s health care system truly be better?
That’s what we want you to tell us.
Wanted: A Better Health Care System In America” was summarized from hundreds of focus groups across the United States. Participants provided their views on how U.S. health care can be improved, which was summarized by the AHA into six principles:
From these principles, Texas Health Resources (THR) developed an additional principle:
The "Creating a Health Care Policy for America" document is from the Texas Institute for Health Policy Research in Austin, Texas. The information quantitatively portrays some of the challenges faced in revising America’s health care policy.
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Lia Lee was a three-month-old Hmong child with epilepsy. Her doctors prescribed a complex regimen of medication designed to control her seizures. However, her parents felt that the epilepsy was a result of Lia "losing her soul" and did not give her medication as indicated because of the complexity of the drug therapy and the adverse side effects. Instead, they did everything logical in terms of their Hmong beliefs to help her. They took her to a clan leader and shaman, sacrificed animals and bought expensive amulets to guide her soul's return. Lia's doctors felt her parents were endangering her life by not giving her the medication so they called Child Protective Services and Lia was placed in foster care. Lia was a victim of a misunderstanding between these two cultures that were both intent on saving her. The results were disastrous: a close family was separated and Hmong community faith in Western doctors was shaken.
How can physicians-in-training prepare for situations like Lia's? Lia was surrounded by people wanting the best for her and her health. Unfortunately, the involved parties disagreed on the best treatment because they understood her epilepsy differently. The separate cultures of Lia's caretakers had different concepts of health and illness.1 To ensure good care for diverse patients, physicians-in-training must address cultural issues in medicine.
By the year 2000, almost 50 million people in the U.S. will be ethnically diverse.2 Immigration contributes to the growing diversity of the U.S. In 1940, 70% of immigrants were from Europe. By 1992, the pool of immigrants had changed so that 15% came from Europe, 37% came from Asia and 44% came from Latin America and the Caribbean.3 The U.S. attracts two thirds of the world's immigration and 85% of American immigrants come from Central and South America.4 Generalist physicians can expect more than 40% of their patients to be from minority cultures.
The health industry is also starting to realize the importance of cultural sensitivity. Michigan Physicians Mutual Liability Company underwrites malpractice policies so that doctors receive a 2-5% premium reduction if they take a seminar on cultural diversity. In addition, The Pennsylvania Health Law Project has been pushing for stronger linguistic and cultural standards in federally funded health programs. According to Dr. Gany, director of the New York Task Force on Immigrant Health, a program to provide simultaneous telephone interpreting for doctors and non-English speaking patients is being launched in 1998 in New York City.6 A $400-million initiative to reduce health differences between minority and white Americans was recently proposed by President Clinton.
What does it mean to be culturally competent?
How do physicians-in-training perform a cultural assessment?
Isn't being a good physician enough to treat everyone?
The patient doesn't speak English, now what?
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THE FEDERALLY QUALIFIED HEALTH CENTER (FQHC) benefit under Medicare was added effective October 1, 1991 when Section 1861(aa) of the Social Security Act was amended by Section 4161 of the Omnibus Budget Reconciliation Act of 1990. FQHCs are “safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless. The main purpose of the FQHC Program is to enhance the provision of primary care services in underserved urban and rural communities. Medicare pays FQHCs an all-inclusive per visit amount based on reasonable costs with the exception of all therapeutic services provided by clinical social workers and clinical psychologists, which are subject to the outpatient psychiatric services limitation. This limit does not apply to diagnostic services. Medicare also pays Rural Health Clinics (RHC) on the same basis.
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The attached Policy Information Notice (PIN) describes the Bureau of Primary Health Care=s expectations for all health center programs covered under section 330 of the Public Health Service Act as amended by the Health Centers Consolidation Act of 1996 (P.L. 104-299).
In addition to requirements for health centers that are specified in law and regulation, Health Center Program Expectations also reflects Bureau priorities and preferences for program funding or aspects of health care programs associated with success. The enclosed Health Center Program Expectations supercedes all previous program expectations issued for Community Health Centers, Migrant Health Centers, Health Care for the Homeless Programs, and Public Housing Health Centers.
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