When an Insurance Card Isn't Enough: The Need for Enabling Services
by The Opportunity Agenda, Mon Mar 16, 2009 at 12:06:15 PM EDT
Americans are demanding, more than ever, change in our health care system. We want meaningful reform that means that we will be able to get the care we need, so that we can be healthier and productive as individuals, families, communities, and as a nation. But when the health care reform debate is narrowed to a discussion of insurance coverage, rather than actual ability to access quality care, the discussion falsely considers health care to be a commodity, like Nintendo Wiis.
But surely we as a country value health more than our gaming consoles; indeed, we believe as a nation that health care is a right stemming from our basic human dignity and America's promise of opportunity, in the same manner as access to our interstate highway system or the protection from disaster provided by our firefighters. True reform of health care in the United States requires a recognition of the wisdom of the adage, "If you don't have your health, you don't have anything." Providing real access to necessary care should be the central mission for how we redesign the broken health care system in America, a system that finds over 1 in 5 Americans unable to pay the bills for necessary medical care or prescription drugs, and 1 in 4 Americans who have put off necessary care in the past year.
Real access to health care requires more than an insurance card in your wallet. Too many working families find barriers to primary and preventative care every day, whether it be due to their local hospital closing and taking a provider network along with it, or as occurs quite often, because they don't have access to needed support or services that is essential to getting to a doctor in the first place. "Enabling services," as they are called, include transportation to a medical provider, childcare during appointments, interpreters for those with limited English proficiency or hearing impairments, case management, health education, and training of medical professionals to provide such services in a culturally competent manner. And they are crucial to not just the ability to access health care, but overall well-being and health outcomes. A 2007 study by the Association of Asian Pacific Community Health Organizations (AAPCHO) found that patients using enabling services had significantly lower hemoglobin A1C (blood sugar) than those not using enabling services. As AAPCHO reported:
“What this study begins to show us is that enabling services, which include translation services and health education, do in fact improve health outcomes for vulnerable and medically underserved Asian American, Native Hawaiian and other Pacific Islander patients,” said Jeffrey B. Caballero, executive director at AAPCHO.
Mr. Caballero further explained, ”With current health care discussions revolving around comprehensive healthcare systems and defining the “medical home”, federal agencies and lawmakers must recognize the true value of enabling services and the CHCs that provide them.”
Many health care facilities provide these sorts of services already, but they are not consistently available, encouraged, or covered by health insurance policies. Making these essential services "reimbursable," that is, something that insurance plans will pay for just as they pay providers for flu shots and check-ups, should be a key of any health reform proposal going forward.Read more at The Opportunity Agenda's blog.