Meirs Kaitlyn W, Howarth Marilyn V
1 Robert Wood Johnson Foundation, Princeton, NJ, USA.
2 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
New Solut. 2018 Nov;28(3):448-462. doi: 10.1177/1048291118795693. Epub 2018 Aug 30.
Residents in Louisiana, Mississippi, and Alabama have experienced repeated natural and man-made environmental exposures. As frequency and intensity of exposures increase, the need for environmental specialty care rises in environmentally overburdened communities. We evaluated access to environmental health expertise in these states. We determined if providers accepted private health insurance and/or self-pay mapping their location using ArcGIS. Of sixty-four physicians meeting inclusion criteria, only eleven (17%) accepted private health insurance and thirty-four (53%) accepted self-pay. The ratio of physicians with environmental expertise who accept private health insurance and/or self-pay, to the population is < 1:1,000,000. Occupational clinics employ specialty physicians to provide care to industry employees but generally not patients with non-work-related exposure. We discuss the implications of limited access to environmental specialty care. To improve the availability of specialty expertise in this region, we recommend increased funding for training physicians in environmental exposure assessment in underserved communities, especially environmental justice communities.
路易斯安那州、密西西比州和阿拉巴马州的居民多次经历自然和人为的环境暴露。随着暴露频率和强度的增加,在环境负担过重的社区,对环境专科护理的需求也在上升。我们评估了这些州获得环境卫生专业知识的情况。我们确定了提供者是否接受私人健康保险和/或自费,并使用ArcGIS绘制他们的位置。在符合纳入标准的64名医生中,只有11名(17%)接受私人健康保险,34名(53%)接受自费。接受私人健康保险和/或自费的具有环境专业知识的医生与人口的比例小于1:1,000,000。职业诊所聘请专科医生为行业员工提供护理,但一般不为与工作无关的暴露患者提供服务。我们讨论了获得环境专科护理机会有限的影响。为了提高该地区专科专业知识的可及性,我们建议增加资金,用于在服务不足的社区,特别是环境正义社区培训医生进行环境暴露评估。