health care reform

health care reform
health care reform is part of an ongoing debate and recent substantial legislation.  Address the following your paper: in what ways have recent health care reform measures expanded or inhibited access to care?  How might changes to access influence utilization? Explain the concept of what universal health care may be, and how current care reflects or contrasts with this?
John Q. recently moved to a rural community.  Works full time, qualifies for Medicaid from low income, has high blood pressure and dad recently had heart attack.  Deciding to find a dr nearby who accepts Medicaid, no local drs accepted the insurance and closest accepting physician was 40 mins away.  Appts were made in 2 weeks advance and doesn’t offer evening or weekend hours.  John uses public transportation or gets a ride to work with a friend.
According to Chapter 4 of the US health system: origins and functions, Anderson (1995) developed a model of health services utilization based on 3 categories of factors: predisposing, enabling and need.  These factors can be further categorized as mutable or immutable.
Discuss the following questions:  What factors may affect John’s health care utilization?
Are these factors mutable or immutable?
What are some ways to change the mutable factors?