MODULE 8: Access to Healthcare & Insurance (Last Review 5/1/24)
Module Presentation
Learning Objectives
To define what access to healthcare means
To identify barriers to accessing healthcare, why they occur and the disparities that occur as a result
To provide some guidance on how to assist patients with healthcare access
Explore the different types of insurance available in the United States
Define common terms used in insurance
Explore the requirements for different forms of health insurance
Discuss options available for healthcare outside of health insurance
Discuss factors that impact ability to have and maintain insurance and access healthcare
To better understand how a lack of insurance affects ED utilization
To better understand we as emergency physicians can best assist patients with their care as related to prescriptions and follow-up care
To better understand how to help patients requiring financial assistance and/or management of their medical debt
Literature Review
Textbooks
Alter HJ et al. Social Emergency Medicine: Principles and Practice. 1st ed. Springer Cham; 2021. doi: 10.1007/978-3-030-65672-0
Articles
The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians (10.1080/08998280.2001.11927785)
The Oregon Experiment — Effects of Medicaid on Clinical Outcomes (10.1056/NEJMsa1212321)
Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance (10.1001/jamainternmed.2016.4419)
The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations (10.1146/annurev-publhealth-031816-044555)
Affordability of health care under publicly subsidized insurance after Massachusetts health care reform: a qualitative study of safety net patients (10.1186/s12939-015-0240-5)
Medical bankruptcy in the United States, 2007: results of a national study (10.1016/j.amjmed.2009.04.012)
Income, Poverty, and Health Inequality (10.1001/jama.2018.2521)
The cost of an emergency department visit and its relationship to emergency department volume (10.1016/j.annemergmed.2004.08.029)
Paired Resources
FOAMED
IDHEAL Social EM modules. Module 17: Healthcare Coverage and Access to Health Care
Supplemental Materials
Sim cases/Case studies
Case + discussion qs in lectures -- Sam in Access to Healthcare slides, Jean in Insurance 101 slides, Randy in Impact of Insurance on EM
Key Websites
KHN. More States to Consider Extending Postpartum Medicaid Coverage Beyond Two Months
LA County Health Services. My Health LA -- options in Los Angeles County
Program Eligibility by Federal Poverty Level for 2023 -- Your financial help and whether you qualify for various Covered California or Medi-Cal programs depends on your income, based on the Federal Poverty Level (FPL)
Street, Occupy Wall. "The Debt Resistors’ Operations Manual." New York, Strike Debt/Occupy Wall Street; 2012:23-29 -- Section on Medical Debt starting p. 23
Assessments