Healthcare in the United States
Healthcare in the United States is mainly offered by different legal entities. Many of the healthcare facilities are predominantly owned and managed by the private sector. In contrast to this, the government within the public sector predominantly offers most of the healthcare insurance. This is done through various organizations such as Medicaid, TRICARE, Veterans Health Administration, and Medicare. It is thought that most of the population below 65 years gets insurance from their employers, while others have purchased their own from health insurance brokers and others are uninsured. Now, there is an ongoing debate about the healthcare reforms in the United States. Debate has mainly focused on costs, efficiency, equitable access, value, and quality of services rendered. Some critics have argued that the American healthcare system is incapable of delivering value for money spent on healthcare. Various studies carried out on the United States healthcare system have revealed the failure of the United States to provide its citizens with equitable access to healthcare. For the purpose of this research paper, the expanding access in healthcare has been explored (Shi & Singh, 2011).
Expanding Access in Healthcare
Access refers to the ability on an individual to get medical healthcare when and where it may be required. From a broader perspective, access refers to the ability of getting affordable, acceptable, convenient, and effective medical care services when needed. It may also refer to the availability of healthcare to a person in society. This is in respect to whether the person is capable of using healthcare services or shows the acceptability of healthcare services to the general society. Access to care has a fundamental bearing on health and healthcare delivery systems. In this case, measurement of access reveals or shows the extent to which delivery of healthcare is viewed as being equitable. Access to healthcare is also associated with the quality and efficiency of the required health services. Access is an important benchmark used in the measurement of the effectiveness of the healthcare delivery system. In addition, access to healthcare is one of the major definers of health in conjunction with lifestyle, heredity factors and environment (Shi & Singh, 2011).
For access of healthcare to be termed as equitable, distribution of medical services must correspond to the patient’s perceived needs. This should also be based on the diagnosis of a qualified medical practitioner. On the other hand, access is termed to be inequitable where the medical services are distributed in relation to the ability of a client to pay for the services and social standing of the patient. Access can be measured at three distinct levels starting from the health policy, individual, and mode of delivery. Currently, in the United States, there are many barriers to health care access experienced at the individual and system levels. Most of these barriers affect the most vulnerable groups in the American society. In the United States, access is determined by three basic and interrelated factors. These include occupation, income, and race. Research indicates that people from minority groups are usually poor. Such individuals have low levels of education and often get employment in jobs that predispose them to high health risks. For example, Americans living in the rural areas experience many barriers because they have low incomes. They are mostly challenged by age compared to the urban population and usually suffer from chronic diseases. According to a previous national survey, healthcare stakeholders and leaders place first priority on access to efficient, reliable, and quality health care services. It has been reported that the United States has a big surplus of facilities in urban areas, such as medical staff and hospital beds. However, these resources are not reallocated to areas that they are needed the most (Andersen, Rice &Kominski, 2007).
Access to healthcare is important in promoting and sustaining the well-being of a population. When people are enabled to gain access to medical care, they have high chances of getting primary, preventive, services such as immunization and education on personal conduct. This also enables early detection and prevention of diseases before they become chronic. It is unfortunate that access to medical healthcare today remains elusive to many American citizens. A big proportion of the United States population is not sufficiently catered for by the existing health care system, and many Americans have unmet healthcare needs. This phenomenon is widely experienced among the vulnerable groups of the American society. There are very many and complex factors that pose problems to access of healthcare, they range from economic, structural, geographic, social, and cultural factors. The result of inadequate access to health care is that it contributes to poor health of the individual and population at large. Failure to seek treatment can be associated with improper use of emergency services and facilities (Williams, 2011).
Various agencies within the department of health and human services (HHS) in conjunction with other federal departments have tried to develop strategies and facilities aimed at improving access to quality healthcare by the various vulnerable groups of the American population. Programs run by agencies such as the Center for Disease control and Prevention (CDC) and Health Resources and Services Administration (HRSA), among other agencies have mainly been based on the dynamic dimensions of the healthcare system. This has involved increasing the number of medical professionals, strengthening of the healthcare infrastructure, offering direct healthcare to vulnerable groups such as veterans, pregnant women, and provision of community based services. In addition, they also give technical knowledge on healthcare issues to the local health state departments, carry out national surveys, financing basic and applied research, and carrying out public education exercises. Complementary to the federal strategies, other stakeholders are encouraged to increase financing community healthcare programs and take steps to address the inequality of access to the healthcare system by the vulnerable groups in society. In response, the private sector has financed several voluntary, community programs. A good example is the Mission for Mercy program that is behind temporary clinics mainly staffed by volunteering medical professionals. Normally, they are established in areas where the population can get easy access to and mainly operate on a first-come, first-served rule (Committee on Oral Health Access to Services (U.S.), National Research Council (U.S.),& Institute of Medicine (U.S.), 2011).
According to the institute of medicine, access is a term used to encompass all the concerns that affect the extent to which groups and individuals in society get medical services from the existing medical care system. There are challenges in explaining the meaning of access to healthcare. However, it has usually been linked to lack of insurance cover and the lack of enough medical professionals and hospital facilities in the affected areas. When an individual has proximity to a health facility, this does not guarantee that this person may have access to medical services. In contrast to this, there are many people who live far away from healthcare institutions and may not have insurance covers do get medical services from healthcare givers. Probably, the best and most effective attempt to define the meaning of access to health care and equity was delivered by the 1983 Presidential Commission. It held that, for equitable access of healthcare to exist, individuals in society should be able to acquire reasonable care without a lot of burden. As laid down by the commission, the process of making this moral obligation a reality can be hard. This is because deciding on the sufficient level of care can be challenging. What constitutes an excessive is relative, and knowing whether these standards have been obtained is difficult. When the IOM committee was evaluating ways of resolving this conflict of ideology, it became apparent that outcomes are as important to the meaning of access as is the utilization of services. After all considerations, the IOM committee defined access as “the timely use of personal health services to achieve the best possible health outcomes” (Institute of Medicine (U.S.) &Millman, 1993, p. 33). It can be noted that this definition depends on both the health outcomes and healthcare services to provide benchmarks for assessing whether access has been attained. Access is just one of the various aspects that influence healthcare services and the required outcomes (Institute of Medicine (U.S.) &Millman, 1993).
The United States health care system has been trying to give access to healthcare services to all its citizens for quite some time. In the 20th century, some of the fundamental achievements have been the growth of the private sector, establishment of Medicaid and Medicare programs, the health insurance covers, and the raise of federal efforts in disseminating health care programs. In 2010, Congress oversaw the passage of the Patient Protection and Affordable Care Act (ACA) into law. This is anticipated to lead to a widened insurance cover for all American citizens. It is expected that the ACA will bring down the number of individuals who are not insured. Research has documented the impact of not being insured and the advantages of being insured. For people with insurance covers, it is noted that they usually have a definite source of healthcare as compared to individuals without a health insurance cover. It has also been noted that, having many uninsured patients has negative impacts on the healthcare system. Healthcare providers tend to shift the extra costs to other patients to subsidize losses incurred from patients without medical covers. The authors of the ACA constantly referred to the absence of healthcare coverage and its implications as the principle reasons for backing the reform legislation.
However, access to healthcare cannot be viewed from a single perspective. The case of the underinsured reveals that the insurance card on its own cannot eliminate other barriers that hinder access to health care services. Other issues should be considered too. Such issues include size and adequacy of the coverage; whether the insurance policy caters for both outpatient and inpatient services; whether it includes costs of prescribe drugs; whether it covers mental health issues, substance abuse and so much more. It is estimated that about 61 million Americans are underinsured meaning that their insurance covers are not sufficient to assure access to healthcare (Kovner, Knickman& Jonas, 2011, p. 153). Similarly, the payments made to the health care givers are not sufficient. For example, the low payment rates to medical professionals in Medicaid have hugely had a negative impact on the program, as physicians are not willing to participate in it. This has greatly limited the locations from which Medicaid patients can get medical care. It is also noted that insured patients may also encounter noneconomic barriers that may have a drastic effect on health outcomes, utilization of health services and access. Throughout the United States, the provision of healthcare remains uncoordinated and enormously fragmented. This makes it very difficult for the patient to get efficient and quality services (Kovner, Knickman& Jonas, 2011).
In the United States, race or ethnicity is more or less intertwined with the social economic status of an individual. Research has further attributed most of the ethnic and racial inequalities in healthcare provision to socioeconomic statuses. It was noted that the high rate of liver deficiency was because of hereditary causes among the Asian immigrants. Researchers argue that the status of minority groups is a fundamental factor in how healthcare services are used, as well as the impact on the outcome of health care usage. In researches where adjustments were made for differences in insurance coverage, it was noted that African Americans suffering from the end stage renal disease had a 50% less chance of getting a kidney transplant when compared to the white Americans who received transplants. However, when they finally got a kidney transplant, it was noted that they had waited for a considerably long period (Gaston, Ayres, Dooley &Diethelm, 1993).
In general, the bearing of culture and acculturation on health care systems is not clearly known. It is assumed that cultural barriers might lead to limited utilization of healthcare especially among the Hispanic and Asian immigrant groups. These barriers may involve a wide range of probable problems including, lack of trust of modern western medicine, isolation of the society, different perceptions about the disease and illness, general fears of their immigration status especially if they are not registered, and availability of alternative health care services. Researches have been carried out to investigate the extent to which acculturation tends to resolve these barriers. This research has been limited by the inefficiency of defining and accrediting the levels of acculturation. Some of the researchers argue that proficiency in language may be the best evidence of acculturation in facilitating health care access (King, 1999).
Access to healthcare is influenced by very many factors some coherent and other incoherent. Although the United States government has achieved considerable progress in ensuring equitable access to healthcare systems, there is a lot that needs to be done. Notably, the private sector owns a considerable number of healthcare facilities. The federal government should allocate significant resources in the health sector to facilitate the achievement of meaningful gains. The government should come up with laws that will encourage private sector involvement in community-based projects. This can be in the form of tax cuts for organizations that offer free medical clinics.
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