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Health
Care Providers
and Medicines
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Increase
the number of primary health care physicians per 100,000 people in
all areas of North Carolina.
Developmental
Objective, baseline data to be collected in 2001.
Increase
the number of minority and ethnic physicians in the workforce.
Developmental Objective, baseline data to be collected
in 2001.
Increase
the number of dentists who accept Medicaid payments for services.
Developmental Objective, baseline data to be collected
in 2001.
Increase
access to medications for Medicare and Medicaid recipients.
Developmental Objective, baseline data to be collected
in 2001.
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Changes in the health care system,
including the increasing influence of market forces and changes in
payment and delivery systems, have significant implications for vulnerable
and at-risk populations. Each age group has unique challenges to accessing
quality health care. |
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Access
to Effective Preventive Care, Primary Care Services, and Health
Care Providers
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People must have access to clinical preventive
services and health care providers for preventing disease or detecting
asymptomatic disease or risk factors. Today, there are adequate numbers
of physicians in North Carolina. There are 84.5 primary care physicians
per 100,000 population. (Primary care includes general practice, internal
medicine, pediatrics, ob/gyn, and family practice). However, poor
geographic distribution and a high number of specialists often means
that primary care physicians are not available for all North Carolinians.
North Carolina has four major medical schools and research centers.
In 1993, there were 225 North Carolina medical school graduates in
training or practice with an initial residency choice of primary care.
Five years later, in 1998, only 187 of the 1993 graduates were still
working in primary care patient practice setting.
Minority races and Hispanic/Latinos are
poorly represented in the medical profession. In 1998, there were
722 African American/Blacks, representing 4.8 percent of the physician
workforce; the 38 American Indian physicians represented 0.3 percent,
and the 175 Hispanic/Latino physicians represented 1.2 percent.
Because of cultural and language differences, Minorities and Hispanic/Latinos
often seek out health care from professionals with similar backgrounds.
If the physician workforce does not mirror the ethnic and racial
diversity of the population to be served, it is more likely that
minority populations will have more difficulty in accessing essential
health care services.
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Barriers
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Health provider barriers to delivery
of effective services include limited time, lack of training specifically
for the needs of older adults, and lack of training in prevention
and health promotion. Patient barriers to health care services
include lack of knowledge, skepticism about the effectiveness of prevention,
lack of a usual source of primary care, lack of money to pay for preventive
care, and the rapidly increasing costs of medicines.
System barriers
include lack of resource or attention devoted to prevention, lack
of coverage or inadequate reimbursement for services and lack of systems
to trace the effectiveness and quality of care. Having a primary care
provider as the usual source of care assures integrated, accessible
health care services by clinicians who will address personal health
care needs. |
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Access
to Dental Care
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North Carolina ranks 47th in dentist-to-population
ratio. Additionally, dentists overall are in short supply in North
Carolina with 38 dentists per 100,000 population (national average
is 60 per 100,000). There are only 43 pediatric dentists for the whole
state. Furthermore, there is mal-distribution of dentists in the state,
four counties have no dentists in practice, and 36 additional counties
have no dentists who accept Medicaid. Seventy-nine counties qualify
as nationally recognized dental professional shortage areas. A similar
shortage exists for dental hygienists. Only 16 percent of the dentists
in North Carolina participate in the Medicaid program (1998). A 1996
survey of North Carolina dentists showed that 56 percent of dentists
in the state would be willing to see more Medicaid patients if rates
were increase to 80 percent of the usual, customary, and reasonable
rates. There is also a shortage of dentists who provide dental care
for older adults in nursing homes. Approximately 75 percent of the
44,000 North Carolina citizens who reside in nursing homes are Medicaid
recipients. Only 30 percent of facilities report the ability to obtain
needed dental care for their residents. Medicaid recipients’
use of dental services varies by county, ranging from a low of 10
percent of all Medicaid recipients in Alexander County to a high of
26 percent in Henderson and New Hanover counties. |
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Access
to Medications
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Older adults have higher morbidity
rates than their younger counterparts; many have chronic conditions
and disabilities. Forty percent of those 75 years and older have two
or more chronic illnesses. Medicare doesn’t cover medications.
January 2000, only one Medicare HMOs currently available in six counties
in North Carolinians offers drug coverage. Those 65 years and older,
who constitute 12 percent of the population, consume 33 percent of
all prescription medications. National spending for prescription drugs
has tripled since 1990. In the first quarter of this year, drug prices
have risen 4.2 percent. Older North Carolinians, especially those
with low incomes, commonly cannot afford their medications, and may
be unable to follow a physician’s orders. They must choose between
medications and other basic necessities. A current proposal to provide
prescription drug benefits through Medicare for recipients with incomes
below the poverty level will not provide any help to the 428,000 North
Carolina Medicare beneficiaries with incomes above that level.
Given the high prevalence of chronic disease
and disability in this population, polypharmacy is common. Older
adults taking multiple medications must be well informed about the
complexities and dangers associated with these regimens. Physicians
and pharmacists, increasingly faced with productivity pressures,
are finding it more difficult to educate their patients. The recent
practice of direct advertising of pharmaceuticals to the public
exacerbates these problems.
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