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 most of the healthcare insurance is predominantly offered by the government within the public sector, this is done through various organizations such as Medicaid, TRICARE, Veterans Health Administration and Medicare. It is generally thought that most of the population below 65 years get insurance from their employers, while other have purchased their own from health insurance brokers and others are uninsured. Currently there is a lot of debate going on about the healthcare reforms in the United States. Debate has mainly focused on costs, efficiency, equitable access and 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 that the United States as one of the most developed and industrialized nations has not been able to provide its citizens with equitable access to healthcare. For the purpose of this research paper we will explore expanding access in healthcare (Shi & Singh, 2011).
Expanding Access in Healthcare
Basically 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 or whether the person is capable of using healthcare services or shows the acceptability of health care services to the general society. Access to care has a fundamental bearing on health and health care delivery systems in that, measurement of access reveals or shows the extent to which delivery of health care is viewed as being equitable; access to health care 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 health care delivery system; and finally access to health care is one of the major definers of health in conjunction with lifestyle, heredity factors and environment (Shi & Singh, 2011).
For access of health care to be termed as equitable, the distribution of medical services must deemed to correspond to the patient`s perceived needs or 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. Basically 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 a lot of barriers to health care access experienced at the individual and system levels. Most of these barriers affect the most vulnerable group in the American society. In the United States access is determined by three basic interrelated factors namely occupation, income and race. Research has shown that individuals from minority groups are usually poor; generally 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 more barriers because they generally have low incomes, they are mostly challenge by age compared to the urban population and usually suffer from chronic diseases. According to a previous national survey health care 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 but the problem is that these resources are not reallocated to areas that they are needed the most(Andersen, Rice & Kominski, 2007).
Access to health care is important in promoting and sustaining the general health and 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 health care in this present day and age still 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 American have unmet health care 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 health care, 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 health care among the most vulnerable groups of the American population. Program run by agencies such as center for disease control and prevention (CDC), health resources and services administration (HRSA), among other agencies have mainly been based on the dynamic dimensions of the health care system. This has involved increasing the number of medical professionals, strengthening of the health care infrastructure, offering direct health care to vulnerable groups such as veterans, pregnant women and provision of community based services. In addition they also give technical knowledge of health care 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 of community health care programs and take steps to address the inequality of access to health care system by the vulnerable groups in society. In response the private sector has financed several voluntary community programs. A good example can be the Mission for Mercy program which are basically temporary clinics mainly staffed by volunteering medical professionals. They are usually set up in areas which 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 broadly encompass all the concerns that affect the extent to which groups and individuals in society get medical services from the existing medical care system. It is argued that due to the difficulty of explaining the meaning of access, it has usually been linked to lack of insurance cover and the lack of enough medical professionals and hospital facilities in the affected areas. Just by the fact that an individual my have proximity to a health facility, does not guarantee that this person may have access to medical services. In contrast to this many people who live far away from health care institutions and may not have insurance covers do get medical services from health care 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 health care to exist each individual in society should be able to acquire reasonable care without a lot of burden. As laid down by the commission, however the process of making this moral obligation a reality can be hard, because deciding on what is actually 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 were made 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, p. 33, 1993). It is important to note that this definition depends on both the health outcomes and health care services to provide benchmarks for assessing whether access has been attained. Access is only but one of the many factors that influence health care services and the required outcomes (Institute of Medicine (U.S.) & Millman, 1993).
The United States health care system has for ages been trying to give access to health care services to all its citizens. 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 passed the Patient Protection and Affordable Care Act (ACA) into law. It is anticipated to lead to a widened insurance cover for all American citizens. It is estimated that this new law will reduce the number of people who are not insured. Research has documented very well 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 health care as compared to individuals without a health insurance cover. It has also been noted that having many uninsured patients has negative effects on the health care system. Health care providers tend to shift the extra costs to other patients to subsidize losses incurred from patients without medical covers. It is not a coincidence that the authors of the ACA constantly made reference to the lack of health care coverage and its implications as the principle reasons for backing the reform legislation.
However access to health care can not be viewed from a single direction. As the case of the underinsured reveals that the insurance card on its own can not eliminate other barriers that hinder access to health care services. There are various issues that need to be considered such as size and adequacy of the coverage, whether the insurance policy caters for both outpatient and inpatient services, does it include costs of prescribe drugs, whether it also 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 enough to assure access to health care (Kovner, Knickman & Jonas, 2011 p. 153). The second side to the coin would be are the payments made to the health care givers sufficient. For example the low payment rates to medical professionals in Medicaid have hugely had a negative impact on it 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 non-economic barriers that may have a drastic effect on health outcomes, utilization of health services and access. Throughout the United States the provision of health care still remains uncoordinated and enormously fragmented, which makes it very difficult for patient to get efficient and quality services (Kovner, Knickman & Jonas, 2011).
In the United States race/ethnicity is more or less intertwined with the social economic status of an individual. Research has further attributed most but not all, ethnic and racial inequalities in health care provision to socioeconomic statuses. It was noted that the high rate of liver deficiency was as a result of hereditary causes among the Asian immigrants. Researchers argue that the status of minority groups is in its self a fundamental factor in how health care services are made use of and also had an 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 with end stage renal disease had a 50% less chance of getting a kidney transplant when compared to the white Americans who received transplants. But when they finally got a kidney transplant it was noted that they had been on the waiting list for a considerably long period of time (Gaston, Ayres, Dooley &Diethelm, 1993).
Generally the bearing of culture and acculturation on health care systems is not clearly known. It is assumed that cultural barriers might lead to less utilization of health care 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 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 to what extent acculturation tends to resolve these barriers. This kind of 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 health care is influenced by very many factors some coherent and other incoherent. Although the United States government has made a lot of progress in ensuring equitable access to health care systems, much more needs to be done. Most of the health care facilities are owned by the private sector, the federal government needs to allocate more resources in the health sector if meaningful gains are to be achieved. The government should come up with legislations that will encourage private sector involvement in community based projects, such as tax cuts for organizations which offer free medical clinics.
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