The community's ability to access to health care is an integral dimension of the health care system. In 1998, the percentage of persons without health insurance in the state of Texas was 24 percent. On the national level, the U.S Bureau of the Census reports that 16.3 percent of Americans lacked health insurance in 1998. These persons have traditionally been those at or below the poverty level. A growing number of individuals and families without health insurance are the working poor whose incomes are used to meet basic necessities and leaves little for health coverage.
When considering access to health care, many think of access to services to maintain an individual's physical health and do not consider mental health needs. In reality, mental illness affects many members of the community and often goes untreated. It is reported that 22 percent of the population has a diagnosable mental disorder and that mental illness is second only to heart disease as the leading cause of disability. Additionally, nearly two-thirds of all people with diagnosable mental disorders do not seek treatment. This problem has developed because of access issues surrounding having no health insurance, lack of sufficient insurance coverage for mental health related conditions, a sense of hopelessness about recovery, and the stigma associated with mental illness and its treatment. Surgeon General Satcher reports that this problem has derived from mental health issues being "an afterthought or an offshoot" of mainstream health care (Mental Health Resources, about.com, September 2000).
The growth in the number of uninsured residents has strained the local health care safety net, resulting in a rising number of residents who delay care or seek non-urgent care in hospital emergency rooms. Health care providers and related human service agencies in the region have participated in cooperative efforts to improve the delivery of services to low income and uninsured populations. Numerous Travis County safety net providers came together to form the Indigent Care Collaboration (ICC).
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Indigent Care Collaboration (ICC)
The Indigent Care Collaboration is comprised of organizations and individuals who provide physical (including dental) and mental health care to the indigent in the Austin/Travis County area. Its broad goal is to enhance the accessibility, continuity and quality of care provided to the indigent by utilizing effective care management techniques, integrating clinical systems, and reducing administrative barriers, duplications, and cost. Members of the ICC include: ARC for the Homeless; Austin Medical Education Programs; Austin Recovery; Austin Travis County MHMR; Austin/Travis County Health and Human Services Department; Austin/Travis County Primary Care Department; Children's Wellness Center; David Powell Clinic; El Buen Samaritano; Hogg Foundation for Mental Health; Lifeworks; Manos de Cristo; People's Community Clinic; Planned Parenthood Texas; Salvation Army; Seton Healthcare Network; St David's HealthCare Partnership; St. David's Health Care System; Texas Department of Health; The Austin Project; and Volunteer Healthcare Clinic.
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Medical Assistance Program (MAP)
The Medical Assistance Program is an innovative publicly funded city/county program that provides access to a continuum of health care services to Travis County residents with incomes up to 100 percent of the federal poverty level. As of January 2000, MAP had an average monthly enrollment of 10,414. This represents a six percent increase over the average 1998 monthly enrollment (personal communication with MAP office, January 2000).
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Children's Health Insurance Program (CHIP)
This insurance program is designed for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance. The parents in some of these families have jobs that do not offer health insurance for children. Other parents' jobs offer health insurance, but the insurance is so expensive that families cannot afford it. The CHIP benefits package has been designed specifically to meet the needs of children under age 19. CHIP covers services such as hospital care, surgery, x-rays, therapies, prescription drugs, mental health and substance abuse treatment, emergency services, eye tests and glasses, dental care, and regular health check-ups and vaccinations. As of December 14, 2000, the total number of children enrolled in CHIP in the MSA was 8,414; 4,921 of those enrolled live in Travis County.
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Medicaid
Medicaid is an entitlement program for health care. The federal government establishes a set of eligibility requirements and benefits in the program. Anyone who applies and meets those eligibility standards must receive the benefits. All Medicaid services must be available on a statewide basis and may not be restricted to residents of particular localities. In 1997, Travis County Medicaid expenditures, excluding hospital disproportionate share payments, was $179,494,238 with an unduplicated count of 60,342 Medicaid recipients (Texas Health and Human Service Commission, August 2000).
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Other Access Barriers
Access to health care is more than just the ability to pay for services. There are a number of other significant barriers to care. As pointed out, the distribution or location of services makes obtaining health care less convenient for some residents. The hours of operation are not always accommodating for working families. Also, cultural and language issues are frequently obstacles to obtaining care. An additional barrier that affects access to health care is the stigma associated with the condition for which an individual seeks treatment as well as the act of seeking treatment itself.
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