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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