Agenda - 03-09-1999 - III-B - Laserfiche WebLink

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52 JOURNAL OF PUBLIC HEALTH MANACEtaw AND PRAcncE /MARCH 1997 Impact As outlined in- Healthy People 2000, large health disparities exist for certain racial/ethnic groups; par- ticularly at high risk are African Americans and American Indians /Alaska Natives .32 In addition, re- cent data suggest erosion of gains in life expectancy from earlier birth cohorts (e.g., among African American males) .33 Unless the factors largely respon- sible for health disparities (i.e., infant deaths, cardio- vascular disease, cancer, homicide) are addressed more fully, we can expect a leveling or decline in the health status of the overall population.94 Because of the shift in proportions of racial /ethnic groups noted earlier, new health issues are likely to be encoun- tered. Many of the current epidemics affecting younger age groups in minority populations are likely to continue and will need particular attention. These include human immunodeficiency virus /ac- quired immune deficiency syndrome transmission, substance abuse, violence, conditions resulting from the lack of prenatal care, control of sexually trans- mitted diseases, and teen pregnancy. It is important to note that although race is commonly cited as a risk factor for poor health status, the underlying factor is largely poverty.31 Trend Changes in health care delivery systems. Evidence The United States spends more per capita on health care than any other country in the world -14 percent of our gross domestic product in 1994.29 Of the total health care budget, only about 3 percent is allocated to prevention.3° Primarily due to concern about rising costs, the health care system is currently Primarily due to concern about rising costs, the healthcare system is currently undergoing profound changes that will influence public health and health care greatly in the coming decade. undergoing profound changes that will influence public health and health care greatly in the coming decade. Managed care organizations, specifically health maintenance organizations, have grown from enrollments of 6 million people in 1976 to 50 million in 1994.37 Within the next decade, 80 to 90 percent of the insured 'population will receive its health care through various forms of managed care.' Impact The traditional governmental role in public health of providing clinical, preventive services is changing and is likely to evolve further. As underserved populations are increasingly moved into managed care settings, fewer health depart- ments will provide services directly to clients. Changes within the Medicaid and Medicare pro- grams also are likely to influence prevention oppor- tunities among vulnerable populations (i.e., persons of low income, the elderly, and the disabled). At the present time, there is little assessment of the effects of these changes in health care coverage for underserved populations; it is thus unclear whether recent changes will have overall positive or nega- tive effects on the health of the public.3e In order for managed care companies to enhance the overall health of the public, they will have to be responsible for the communities they serve, in much the same way public health departments have been in the past. Because these companies will be paid on a capitated basis, it will be in their best interest to minimize disease and injury risks.39 To do this effec- tively, it seems likely they will play a larger role in the kinds of assessment, advocacy, and assurance activities traditionally the bailiwick of public health workers .2U13 It is unlikely that economic incentives alone will be sufficient for consistent efforts in risk minimiza- tion and increased service coverage when some pre- ventive activities are long -term and effectiveness is uncertain. Therefore, for private reform efforts to succeed, public health must fully assume the as- surance role by serving as a leader and catalyst in providing those oversight functions that only gov- ernment can perform.' Public health agencies can provide a vital function in the managed care environ- ment by providing external incentives —i.e., consis- tent and timely feedback on health outcomes to pro- viders of health care. In conjunction with the changing health care sys- tems, the demand for personnel in various medical 92 • •