How a local health plan is fighting a national trend
Women are strong, but “U.S. women are sicker, more stressed, and die younger compared to women in other countries…” That quote from the co-author of a recent study by the Commonwealth Fund lays out the findings in plain terms and illustrates a problem that has existed for years. American women have long lagged behind women in other wealthy nations when it comes to access to health care and their health outcomes. It’s a shameful situation. As the richest economy in the world, the U.S. should be able to ensure all people in this country have equitable access to health care to have a healthy life.
The Commonwealth Fund study titled Health and Health Care for Women of Reproductive Age found that American women between the ages of 18 and 49 scored worse on just about every major health metric compared to women in 10 other high-income countries, with U.S. women having the highest rate of death from avoidable causes, including from complications during pregnancy. They have among the highest rates of multiple chronic conditions, and they are among the least likely to report having a regular doctor. The study found that women in the U.S. spend more out-of-pocket on health care, and nearly half of American women delay or skip care.
SO WHY IS THIS THE CASE?
The study discusses the shortage of primary care physicians across the country where women could receive initial preventive care. It also discusses high tuition for medical students, which is making it tough to bring more physicians into the system. And the authors point to high out-of-pocket costs for maternity care that other countries don’t have. The authors urge U.S. policymakers to look at ways to invest in women’s health.
WHAT CAN BE DONE AT A LOCAL LEVEL?
L.A. Care Health Plan, the largest publicly operated health plan in the country, has taken numerous steps to try to reverse the trend of poor health outcomes among American women.
In 2018, L.A. Care launched Elevating the Safety Net, a $155 million initiative to recruit new primary care physicians into Los Angeles County to serve the most vulnerable communities. This is one way L.A. Care is advancing its commitment to health equity, giving everyone the opportunity to be as healthy as possible. The initiative includes recruitment grants for clinics or practices in the safety net, providers who offer care regardless of an individual’s ability to pay. The initiative also provides student loan repayment for new physicians who agree to work in the safety net for at least three years. And it offers full medical school scholarships to eight students each year based on need and their stated desire to serve low-income communities.
To date, 139 new physicians have been recruited into the L.A. County safety net, 144 physicians have been approved for loan repayments, and 40 students have been given full medical school scholarships.
In addition to trying to increase the number of physicians serving its members and their communities, L.A. Care offers clinical care initiatives to ensure members get the care they need. The health plan uses screening calls and mailings to remind members when they are due for breast and cervical cancer screenings. L.A. Care staff reach out to members who are pregnant and postpartum, with guidance and incentive payments for mothers who complete their postpartum visits. It also offers a program for members experiencing high-risk pregnancies, which provides education and resources, including workshops and health coaches to answer questions.
L.A. Care also has a number of efforts to address chronic illnesses, such as diabetes, high blood pressure, and asthma. There are programs offering educational materials and the opportunity to chat with a health educator or attend workshops. The health plan has also worked to address social factors that affect health outcomes, in part by committing millions of dollars in grants and sponsorships for various projects supporting the areas of food, income and housing insecurity.
While these steps are a start, L.A. Care agrees with the Commonwealth Fund authors who are pushing for greater investment in the U.S. primary health care workforce and an expansion of women-centered primary health care. We cannot stand by and accept that the U.S. continues to lag behind other wealthy nations for women’s health care. That would be an even greater shame.
Katrina Miller Parrish, MD, FAAFP, is chief quality and information executive with L.A. Care Health Plan. Learn more at lacare.org.
