Ensuring Access to Quality Health Care in Vulnerable Communities

Abstract

For millions of Americans living in vulnerable rural and urban communities, their hospital is an important, and often their only, source of health care. As transformation in the hospital and health care field continues, some communities may be at risk of losing access to health care services and the opportunities and resources they need to improve and maintain their health. Integrated, comprehensive strategies to reform health care delivery and payment, within which vulnerable communities can make individual choices based on their needs, support structures, and preferences, are needed.In this Invited Commentary, the authors outline characteristics and parameters of vulnerable communities as well as the essential health care services that hospitals should strive to maintain locally identified by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities. They also describe four of nine emerging strategies-recommended by the task force-to reform health care delivery and payment and allow hospitals to provide the essential health care services, along with implementation barriers and how to address them. While this Invited Commentary focuses on vulnerable communities, the four highlighted strategies (addressing the social determinants of health, adopting new and innovative virtual care strategies, designing global budgets, and using inpatient/outpatient transformation strategy), as well as the other five strategies, may have broader applicability for all communities.

Figure 1

Matrix showing nine emerging strategies to reform health care delivery and payment, the essential health care services, and which of the essential health care services each strategy could address, as identified or suggested by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities. Abbreviation: ED indicates emergency department.

Figure 2

Examples and descriptions of social determinants of health. The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” While this is not a complete list, the social determinants of health given here are among those identified by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities.