Access to Health Care

There are no pulmonology subspecialists or neurosurgeons practicing in Tuolumne County. Local hospital services include full spectrum radiology services, including nuclear medicine, MRI, CT, and angiography. A new cardiac catheterization laboratory has recently expanded local cardiac diagnostic capabilities. Transportation services to and from medical appointments are available to patients for various services, either through local hospital or Health Department programs. An Adult Day Health Care program is available to transport disabled patients adjacent to health care services during the week.

There are six usual sources for financing routine health care.5 Four public sources for coverage include Medicare/ Social Security (primarily for seniors and the disabled), MediCal and affiliated programs6 (primarily for low-income populations), County Medical Services Program (for low-income patients who do not qualify for MediCal), and the Veterans Administration (for veterans of the armed services). The remaining two usual sources for health care financing include private pay and insurance programs. Insurance programs include the Kaiser program as well as many different models of fee-for-service, capitated, and managed care. Additional programs are available to provide focused care for such needs as Family Planning, Sexually Transmitted Disease management, and Cervical or Breast Cancer screening.

Limitations to access are measurable through the monitoring of "preventable hospitalizations." Preventable hospitalizations are defined as "ambulatory conditions such as asthma, diabetes, and hypertension that can often be managed in an outpatient setting."⁷ Studies have utilized hospital discharge rates for these and other specific conditions to identify "preventable" hospitalization rates, and apply these as inverse markers of access to health care.⁸ It should be remembered that, while these hospitalizations are not in a strict sense clearly preventable, and while these numbers are influenced by advances in therapy and uncontrollable environmental factors, they have been identified as a valid marker for access to health care over time.^9,10 Between 1994 and 1999, there was an average of 15.7 preventable hospitalizations, as defined in the 2004 California Healthcare Foundation study, per 1000 MediCal beneficiaries in Tuolumne County under age 65 years, compared with the California statewide average of 18.4 preventable hospitalizations for the same aged population, suggesting slightly better than average stability of these health conditions for Tuolumne County residents than the statewide average. In the same study, a trend was demonstrated showing an improvement in health for those patients receiving care from managed-care MediCal programs. While Tuolumne County remains a fee-for-service MediCal system, there is statewide movement inspired by such research towards managed-care MediCal networks.

While 1016 Tuolumne County zero to 5 year-old children in 2003 were enrolled in MediCal, and 861 were enrolled in the Healthy Families Program (HFP) or the Access for Infants and Mothers (AIM), approximately 100 were uninsured even though they would have qualified for public insurance had they applied.¹¹