Access to Health Services Policy Statement

Access to health services is essential to the well-being of all Americans. Health services help to protect and improve the health of individuals and contribute to the measured health outcomes of communities and populations. Primary care and clinical preventive services contribute toward expanding quality and years of life; help individuals learn, live, work, and play at their highest levels of health and productivity; and contribute toward reducing the impact of income inequality and racial discrimination. 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.

Primary care is an important part of the consultation and coordination necessary for effective access and use of specialty consultation, community and tertiary hospital care, imaging, laboratory service, home health, mental and behavioral health, and dental care. Inadequate access to primary and preventive care results in poor health conditions becoming more advanced and expensive to treat and ultimately an increased financial burden on communities that must pay for emergency, specialty, and uncompensated care. State and territorial health agencies fill a unique and crucial role that is attentive to population health. Through the public health infrastructure, states and territories are able to support healthy environments and communities, create effective interventions to support health behaviors, and support effective clinical preventive services throughout the life course to reduce the burden of low socioeconomic status and promote healthy living. They provide leadership, policy development, and core public health services that lead to better care for individuals, lowered costs for healthcare, and better health for everyone.

PRINCIPLES FOR HEALTHCARE DELIVERY SYSTEMS

A. Access

• All Americans should have access to utilize primary care and other preventive services.
• All Americans should have access to mental, behavioral, and oral health services.
• Appropriate specialty, tertiary, and emergency health services should be available but used only when necessary and accessed when clinically appropriate.
• All Americans should have access to health services that are comprehensive, coordinated, patient-centered, and prevention-focused.
• Health services should be culturally and linguistically appropriate.
• Whenever feasible, health services should be provided in community-based settings close to the individuals and families receiving services and tailored to the particular needs of each community.
• Health insurance coverage is one tool for minimizing financial barriers to the timely use of necessary health services; however, health insurance alone is not adequate to guarantee access to appropriate health services.
• A strong health services safety net—including a system of hospitals, community health centers and other primary safety net providers, school-based clinics, and state and local health departments—should be maintained to ensure that all individuals have access to needed services.

B. Quality

• Clinical preventive services need to be a central focus of healthcare and should be provided to the entire population once clear scientific evidence and affordability of these services has been established.
• Healthcare providers should be culturally competent and trained to recognize and respond to the unique physical, mental, emotional, spiritual, cultural, and developmental needs of those they serve.
• Services should be coordinated, easily accessible, patient-centered, and employ shared decisionmaking, evidence-based medicine, and integrated public health services.
• Electronic health information technology should be used to create a unified personal health record for each person and a population-based public health information system that serves each community.
• Community-based healthcare systems should be patient-centered and should include behavioral health and substance abuse prevention and treatment services, as well as oral health.
• The use of high-grade evidence should be incorporated into clinical decisionmaking, medical management, and benefit design.

C. Priority Populations

• 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 in health based on race, ethnicity, age, sex, gender, socioeconomic status, language, sexual orientation, geographical location, or disability status.
• Service delivery models such as community health centers and community health workers that address the barriers that contribute to health disparities should be seen as essential to health systems improvement.
• Recognizing that steps in prenatal and perinatal care and early in life offer maximum preventive benefit, maternal and child health populations should remain a priority population group for the investment of healthcare resources. Maternal and child health—especially programs that intervene early in life or before conception—should continue to be a priority allocation in the outlaying of healthcare resources.

STATE HEALTH AGENCY ROLE

A. Access

• State and territorial public health agencies should continue to provide leadership to promote integrated federal, state/territorial, tribal, and local solutions to successfully implement national strategies that lead to comprehensive, prevention-focused healthcare to all populations with an emphasis on priority populations.
• States and territories should collaborate with the clinical sector to ensure that the social determinants of health are addressed and to identify, develop, and implement policies that reduce or eliminate barriers to access to comprehensive, coordinated, and high quality primary and preventive health services.
• States and territorial public health agencies should provide leadership to promote policies for comprehensive access for factors that are associated with wellness for all Americans.

B. Quality

• State and territorial public health agencies should advocate for and facilitate the development of 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.
• State and territorial public health agencies should convene and provide tools and technical assistance to enable healthcare providers to incorporate evidence-based clinical preventive services into practice and to integrate and coordinate public health and healthcare services.
• State and territorial health agencies should collect, analyze, and provide data on the quality of healthcare and develop population health indicators to support quality-improvement initiatives.
• State and territorial public health agencies should support healthcare system payment reform that focuses on access, quality, care coordination, and performance (clinical and population health outcomes) instead of on the quantity of services delivered.
• State and territorial public health agencies’ contracts with providers and third-party payers should include standards for assessing and improving the quality of care provided. State and territorial public health agencies should be involved with ongoing regulatory activities related to such providers and facilities.
• State and territorial public health agencies should plan and develop a delivery system infrastructure to enable access to quality health care for all Americans.
• State and territorial public health agencies should continue to improve information systems that bridge public health, clinical care, individuals, and communities and result in improved performance in the overall health system.

C. Priority Populations

• States and territories, in collaboration with federal, tribal, and local partners, should develop and support policies, targeted interventions, and programs designed to enable all people to attain their highest possible level of health.
• States and territories should partner with others to ensure that health services are culturally and linguistically appropriate.
• State and territorial and local health departments should ensure health services address critical public health challenges, including tuberculosis and other infectious diseases, sexually transmitted infections screening, family planning, and cancer screening and diagnosis.

FEDERAL GOVERNMENT’S ROLE

1. The federal government should work with private and public enterprises to support a high-quality and affordable health system that improves population health and includes preventive and primary healthcare services.
2. The federal government should promote collaboration at the federal, state, territorial, tribal, and local levels between programs that facilitate access to care, such as Medicaid and WIC.
3. The federal government should provide assistance to state and territorial public health agencies with the resources necessary to perform the following functions (when relevant to their statutory responsibilities):

• Carry out essential public health services.
• Ensure the availability of the appropriate amount of service providers.
• Support and educate healthcare providers in their state.
• Regulate providers and third-party payers.
• Maintain an adequate safety net for vulnerable populations.

Approval History:

Access Policy Committee Review and Approval on October 17, 2012
Executive Committee Review and Approval on
Ratified by the ASTHO Assembly of Members on
Policy Expires on March 7, 2016
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:

Policy Statements:
ASTHO General Policy Statement
ASTHO Health Equity Policy Statement
Position Statements:
21st Century Health System
ASTHO Newborn Screening Position Statement