Diagnostics & Imaging Week Washington Editor
WASHINGTON — A new survey looking at access to health by women finds that a substantial percentage of women cannot afford to go to the doctor or have their prescriptions filled.
According to the report, "Women and Healthcare: A National Profile," from the Kaiser Family Foundation (KFF; Menlo Park, California), a majority of women are in good health and are satisfied with their healthcare, but many do not get adequate levels of preventive care.
And for those who are sick, poor, or uninsured, the challenges blocking access to healthcare are magnified.
Representatives from KFF presented the findings last Thursday during a presentation at the organization's Washington office. The results are based on a survey of 2,766 women age 18 and older.
As healthcare costs grow, more than one-quarter of non-elderly women (27%) and two-thirds of uninsured women (67%) report that in the past year they delayed or went without care they believed they needed because they could not afford it, compared to 24% and 59%, respectively, in 2001, the report said.
Among women with private coverage, nearly one in five (17%) delayed or went without care. In addition, 20% of women ages 18 and older say they did not fill a prescription in the past year because of the cost.
Fewer than half of all women say they have talked to a healthcare professional in the past three years about smoking (33%), alcohol use (20%) and calcium intake (43%), while somewhat more than half (55%) have talked about diet, exercise and nutrition.
Among women of reproductive age (18-44), fewer than one in three (31%) say they have talked with their doctor about their sexual history and specific issues, such as sexually transmitted diseases (28%) and HIV/AIDS (31%) in the past three years.
Mammography rates reported by women ages 40 to 64 have not improved, falling slightly from 73% in 2001 to 69% in 2004, according to the survey. Only 40% of uninsured women older than 40 had a mammogram in the past year compared to three-quarters of women with private coverage (74%) or Medicare (73%).
Pap testing rates reported among women ages 18 to 64 also fell from 81% in 2001 to 76%. Only 38% of women 50 and older say they have had a colon cancer screening test in the past two years and 37% of women 45 and older say they received a test for osteoporosis in the past two years.
AHRQ outlines HIT efforts on Capitol Hill
Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ; Rockville, Maryland), recently testified before the Senate's Committee on Commerce on her agency's efforts in the area of healthcare information technology (HIT).
In her comments before the Subcommittee on Technology, Innovation and Competitiveness, Clancy said AHRQ's activities complement HHS's efforts "by harnessing the power of IT to improve the effectiveness, efficiency, quality and safety of healthcare."
There currently are eight pieces of proposed legislation involving HIT being considered in Congress.
"For many healthcare providers, the need to address specific local threats to the safety and quality of patient care is immediate, especially as an increasing number of practitioners and organizations have made or will make investments in health IT," she said. "AHRQ's investments support evaluation of the impact of selected health IT applications on quality and safety, with a strong emphasis on the needs of providers who care for rural and underserved populations."
In FY04, AHRQ awarded 108 grants and contracts in the area of health IT, Clancy said. The awards represent roughly $139 million over five years in 43 states, with more than half of the projects based in rural and small hospitals and clinics than serve a total of 40 million people.
AHRQ's programs in HIT center on reducing medical errors, improving the quality of patient care and reducing the cost of healthcare, Clancy explained.
AHRQ research involves using personal digital assistants (PDAs) for electronic prescribing to reduce illegibility, omissions, and the overall incidence of prescribing errors.
The agency also is examining barriers to PDA adoption, including the interface and its interoperability with existing systems. Other projects involve developing Internet-based portals to enable patients to manage their own care, including medications. AHRQ is also funding systems for the voluntary reporting of errors.
The agency also is engaged in telemedicine and web-based systems, particularly in rural areas, as a way to reduce costs.
Clancy said one of the most ambitious projects is the National Resource Center for Health IT, calling it "the largest single commitment to technical assistance in AHRQ's history."
She said the center is designed for "real-world clinical settings" that may feel unable to meet the challenge of HIT implementation. The goal of the program is to facilitating expert and peer-to-peer collaborative learning in an effort to connect individuals and organizations involved in planning, implementing and researching health IT, she said.
The center will offer guidance on how to comply with rules and regulations, how to design workflow, how to evaluate effectiveness, and how to tackle clinical decision support systems.
New system for Medicare appeals
The Centers for Medicare & Medicaid Services (CMS; Baltimore) now offers a new system for appeals by Medicare beneficiaries, providers and suppliers.
The Medicare hearings previously had been handled by the Social Security Administration and now will come under the jurisdiction of the Office of Medicare Hearings and Appeals within the Department of Health and Human Services (HHS).
The new system was mandated by the Medicare Modernization Act of 2003 and became effective at the beginning of this month. The new system will be quicker and more efficient, CMS said. All Medicare claims appeals should be handled within 90 days, as mandated by law.
"As HHS assumes responsibility for handling Medicare hearings, we are committed to making the appeals process better, faster and more convenient for seniors and other people with Medicare," said HHS Secretary Mike Leavitt said. "Our goal is to eliminate the need for an aged or disabled beneficiary to travel if other resources are available closer to home."
HHS said it would be able to reduce hearing timeframes to comply with requirements by using video teleconferencing technology (VTC) with a state-of-the-art electronic hearings process to provide significantly more access points than currently exist. At present, HHS has access to VTC sites in more than 1,000 cities.
HHS said that its administrative law judges would travel to conduct in-person hearings as needed.