Health Utilization Paper
Jana Byers
May, 4, 2015

Mr. John health care utilization may be affected in several ways. The first factor is that he lives in rural area in which the primary care physician is forty minutes away. The passage also mentioned that Mr. John does not have personal transportation. The fact that the primary care physician is not within walking distance increases the likelihood of Mr. John missing a scheduled appointment. If he cannot find reliable transportation to get him to the physician’s office, he may have to re-schedule for a later date. As a result of the uncontrolled hypertension, Mr. John chances of having a heart attack are now increased; especially since he has a family history of heart attacks. But, the upside to this scenario is Mr. John has encouragement to keep his scheduled appointment. He will be more likely to arrive to the appointment because he has to depend on someone else to get him there. Since the appointment has to be scheduled at least two weeks away, Mr. John will have enough time to schedule transportation with the Medicaid driver. Something else to consider is how far will Mr. John have to travel to have any labs or diagnostic test done if the primary care physician does not do the procedures in his facility? With that being said, he may have to miss a whole day of work in order for the Medicaid provided transportation to get him to the necessary location. What if Mr. John is not satisfied with that particular physician? If he decides he does not want to be seen that Dr. So-and-so, Dr. Him-&-him may be located another 40 minutes away. At this time, the transportation factor is immutable as Mr. John cannot afford to purchase a private vehicle. There is a possibility that the distance may be mutable if Mr. John is able to move closer to the urban area. Mr. John’s low income may affect his health care utilization as well. He may have to miss a whole day of work to go to his appointment given that he was transported by the Medicaid transportation driver. He may want to limit his visit so that he does not have to decrease the amount of his income. What is Mr. John to do if he just so happen to consistently have bouts of uncontrolled hypertension? The cycle of scheduling an appointment starts all over again. As mentioned earlier, Mr. John is covered by Medicaid. The primary care physician may order some test on Mr. John that are not covered on his plan. This is another impact on health care utilization. The nurse (or designated staff member) may have to contact the insurance provider to get the test(s) pre-authorized. Sometimes that pre-authorization may take 48-72 hours. If the insurance provider decides not to authorize the test(s), there is a good chance that the patient will be required to pay for the service out of pocket. On that same note, not all medications are covered by Medicaid as well. Mr. John may have to go through the step therapy in order to find the medication that is agreeable with his condition. Keep in mind that “Unc” has to depend on someone for transportation to get him to and from the pharmacy. The pharmacy issue is mutable because he may be able to switch to a pharmacy that will be willing to delivery his medicaitons.