Health Care Utilization John Q

Scenario

John Q. recently moved to a rural community. He works full-time, but qualifies for Medicaid because of his low income. John has high blood pressure and his father recently had a heart attack. Thus, he decided to call to find out which providers nearby accept Medicaid. While there are local doctors, he discovered that the closest primary care physician who accepts Medicaid is a 40-minute drive and appointments must be made 2 weeks in advance due to the number of patients at the practice. In addition, the practice does not offer weekend or evening hours. John usually catches a ride to work with a friend or relies on public transportation. (University of Phoenix, 2012).

Based on the above scenario, John Q. needs to see a doctor to keep from becoming a victim of a heart attack. There are many factors involved with John Q. using health care services. He has a low income, receives Medicare, no local physician available, limited transportation, and yet he has a need to see a doctor. These factors are described as predisposing, enabling, need, mutable, or immutable. The immutable factors cannot be changed, whereas the mutable factors could change. How dose one change them is the question? This question is important because the changes need to be made so that everyone can have access to health care no matter what area they live in.

One of the major factors affecting John Q’s access to health care that the only primary care physician that accepts Medicaid is approximately 40 miles away, and he depend on others or public transportation. John lives in a rural area. Based on Jones (2009), many rural areas do not have sufficient patient volume to support full-service hospitals. Rural areas contain 19% of the population in the United States, but only 11% of physicians (Fordyce, 2007). The number of medical, surgical, pediatric, or other specialists per 100,000 people declined from 138 in urban areas to 58 in rural areas and 17 in isolated rural areas (Fordyce, 2007). Rural areas are normally underdeveloped, which is why there are normally not many physicians and normally no hospitals. Individuals in rural and urban areas differ in terms of culture and other factors. Because of the culture difference between the two, this factor would be predisposing and immutable because culture can not be changed. It could also be described as needed based, because of the fact that physicians are desperately needed in the local rural areas that accept Medicaid and can care for patients.

Johns dose no earn enough income to give him the access to utilize health care. It is difficult for John to work, pay bills, and still pay for doctor visits or insurance, not to mention transportation. Income at this point is considered an enabling factor that could be changed making it mutable (Barsukiewicz, Raffel & Raffel, 2010). One can get promoted, get a second job, or simply get a higher paying job. Of course, a higher income may result in losing his Medicaid coverage, but open the doors to a better quality health care service. A new job or promotion may even come with a change in health insurance status. John may qualify for private insurance, which may be more affordable to him.

In John Q’s case the biggest factor is distance and how to arrive there. The nearest primary care physician is 40 miles away and John does not have a care or does not drive. Transportation is a factor for many in rural areas, as rural areas are not as developed as urban areas. If public transportation is provided, it is usually a long walk to the pick up and drop off area. Also public transportation is normally local and only covers certain areas, 40 miles is more than likely outside the publics transportations route (Mattson, 2010). This is an enabling factor and is mutable, as it could also be changed.

Many of the mutable factors could be changed in some ways. Those factors are income, insurance status, transportation, and access to doctors or hospitals. To change the income, a person can receive a promotion, obtain a higher paying job, or even get a second job. Making such changes could become very hard for most in today’s economy although, a new job or a change in income could also lead to a possible change in insurance status or the ability to pay for health care. An increase in income could also change the transportation situation in the way that one could afford to purchase a vehicle. Transportation could also be changed if a transportation company in the community opened a medical transportation service that picked up and dropped off patients for Medicare, Medicaid, and most other insurances, this could be a huge successful business in rural areas. However; many people find that these types of services are not as reliable, uncomfortable, and costly (Mattson, 2010). The need for physicians could change with development. They could recruit and build hospitals or doctor’s offices. All of these things could be changed and if they do this would make a huge impact on access to health care in rural areas.

John Q lives in a rural area where there is no physician available that accepts Medicaid. His father had a heart attack, and he is concerned about his health. The closest doctor is 40 miles away and John relies on others for means of transportation to travel to work. Therefore; its just about impossible for him to travel such a distance to see his primary physician. These factors would be described as enabling and mutable because they could also be changed. John’s culture would be the one predisposing, immutable factor involved as he cannot change is culture or his beliefs. All of these factors immutable or mutable play a major role in health care utilization. Having access to health care is very important, and it should become more available to everyone because everyone deserves a fair chance at life. No matter how much money one makes, what ones beliefs may be, where one lives, nor ones insurance status.

References:

Barsukiewicz, C. K., Raffel, M. W., & Raffel, N. K. (2010). The U.S. health care system: Combining business, health, and delivery (6th ed.). Mason, OH: Cengage Learning.

Fordyce, Meredith A., Frederick M. Chen, Mark P. Doescher, and L. Gary Hart. (2007, November). 2005 Physician Supply and Distribution in Rural Areas of the United States. Final Report #116, WWAMI Rural Health Research Center, University of Washington.

Jones, Carol Adaire, Timothy S. Parker, Mary Ahearn, Ashok K. Mishra, and Jayachandran N. Variyam. (2009, August). Health Status and Health Care Access of Farm and Rural Populations. Economic Information Bulletin Number 57, Economic Research Service, U.S. Department of Agriculture.

Mattson, J. (2010, December). Transportation, Distance, and Health Care Utilization for Older Adults in Rural and Small Urban Areas. Retrieved on October 20, 2012 from http://www.ugpti.org/pubs/pdf/DP236.pdf

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