Health Care, Immigration and Society: An Analysis of Demand and Supply - Research Paper Example

? Health Care, Immigration and Society: An Analysis of Demand and Supply BY YOU YOUR SCHOOL INFO HERE HERE Executive Summary Immigrant health care is a significant concern in today’s economy. There are social concerns about the stability of the economy due to immigrants flooding low-wage job markets and also racial and ethnic prejudices that impact the quality of health care treatment. This analysis identifies the factors that lead immigrants to demand health care services and analyzes models most appropriate for understanding cultural, economic and social factors in this decision-making. Health Care, Immigration and Society: An Analysis of Demand and Supply Introduction Health care for immigrants is a significant concern for both economists and those who operate and maintain the current national and international health care systems. Especially prevalent in the United States are sharp increases in immigration from Mexico and Asia, regions where the working poor do not have adequate access to jobs and associated health care benefits. While immigrant volumes continue to rise, the U.S. state-level budgets are strained by current national economic conditions, thus causing problems with creating adequate programs to assist these individuals with social programs such as Medicaid. Therefore, immigrants are not receiving the quality health care provision demanded based on micro- and macroeconomic factors as well as social attitudes that are modestly prejudiced against immigrant groups. Immigrants do not access health care services in the same proportion as domestic citizens, due to lack of access to health insurance, socio-cultural factors and also income levels. There seems to be a misconception about why immigrants do not seek health care during times of health distress, thus they are not provided sufficient support or health care provision/programs. This report identifies the factors that impact immigrant health care and provides an analysis using models of demand and supply for investigation. Immigrant Issues Immigrant workers, due to their illegal status in the United States as well as their minimal receipt of secondary education, are provided with low-wage jobs in which they are often exploited as laborers. Hispanics, especially, work in more dangerous jobs and experience higher volumes of traumatic injury than domestic workers (Molina, 2011). In most of these job positions, workers do not receive an adequate wage or benefits package that provide health insurance despite working in dangerous environments. Thus, these immigrant workers continue to provide two specific strains on society. The first burden is the long-term impact on health care costs for domestic workers that occurs when immigrants unable to pay for health care are, by law, provided health care services even if payment is not rendered at the time of treatment. Higher instances of non-payment raises the health care insurance premiums for others and also raises the costs of health care products in the hospital environment significantly. Secondly, immigrant workers are considered, socially, to be unjustified to seize even low-paying jobs especially in regions where the working poor are currently unable to land appropriate and adequate employment. Economic models of demand indicate that as the price of a product increases, the demand decreases and vice versa. Demand models indicate a reverse relationship between cost and need. Health care is notoriously expensive in the United States, even for those who carry health insurance as part of their job benefits packages. However, the immigrant will typically wait until their condition has worsened significantly before seeking health care due to the high costs of attaining adequate or preventative health services. Demand models would suggest that all factors related to social attitudes or immigrant status would remain stagnant while only considering price factors as the variable in the modeling equation. Since price is a significant factor for the immigrant due to their lack of access to quality health insurance, demand is significantly impacted. Price of health care continues to rise yearly, therefore demand for these services is reduced in immigrant and non-immigrant groups. However, domestic citizens would be more apt to seek health care when problems are minor and require minimal treatment than would immigrants since the cost of health care consultation exceed their wage restrictions. There is a danger in relying on merely demand analysis to determine the catalysts for why immigrants are more likely to suffer long-term illnesses for not seeking preventative care due to costs. For example, a recent survey of 10,760 immigrants from China, Korea, Japan and other Asian countries identified that only a slight percentage of children in this sample did not have health insurance; only 13 percent of Korean children were uninsured (Yu, Huang & Singh, 2010). Large-scale studies using a high sample population for analysis identify that small margins of individuals are without access to proper insurance, thus assumptions are made regarding whether to establish new programs or other health care support services to assist these disadvantaged immigrant groups. When considering demand, it is assumed that social or cultural factors will not impact the decision to seek health care, only the price of the services related to personal need and utility. This could well be one reason why immigrants are over-looked when considering a macro-view of the national economy since studies from reputable agencies continue to identify that immigrant needs still represent such a marginal group of individuals in need. For the contractor, it should be considered that there are other factors that continue to drive down demand for services, somewhat arguing against the economic model of demand and also indicating a weakness in using this model as an analysis to assist in immigrant health care. Hoerster, Mayer, Gabbard, Kronick and Roesch (2011) identify that the means of immigrant transportation also greatly impact whether or not they will seek health care services. In low income regions, public transportation is often the only means of mobility especially when wages do not afford the ability to have personal transportation. In most regions of the country, there is adequate supply of health services in private clinics and hospitals which remains relatively constant despite the law of supply which states that supply will decrease when prices decrease. However, the high volume of hospitals and clinics in most regions defy the economic model of supply simply due to volume and choice on the market. For immigrants lacking transportation, they are not impacted by volume and choice or by price (necessarily), instead it is lifestyle and wage restrictions that decrease their demand for health service provision. Using the demand model as a means to explain health care disparities in immigrant groups is not necessarily a valid model since multiple factors determine whether health care is demanded or whether abstainment is the choice. In these immigrant groups, even if the price were reduced marginally and promoted, genuine and unpreventable lifestyle restrictions impede their ability to seek appropriate health care and would not fit the broad economic whole related to society majority. While all of this is occurring, there are social attitudes within the health care field that continue to erode the quality of health care and act as a deterrent for seeking quality health care services in immigrant groups. Interviews were conducted with a small sample of immigrant care workers and it was discovered that there is a preference for maintaining a sense of detachment when working with immigrants in this field. Consider the commentary from a health care worker and also an immigrant that shows this prejudice: “I would like to be more on a professional level. I don’t want to be close and I don’t want to…like, we are really good but I don’t want to go any further” (Bourgeault, Atanackovic, Rashid & Rishma, 2010, p.111). This is an indication of disdain for treating immigrants that has the potential to maintain long-lasting deterrence for seeking health care. Offers one immigrant on the matter: “Physically they’re rougher with you. They will come in the room and not say a word and just grab your arm and start doing an IV” (Bourgeault et al, p.111). Many immigrants hail from collectivist cultures that value group and social harmony and consider the group to be an important lifestyle and identify-building factor in their social lives. There is a sense of pride in some immigrant cultures that is valued in relation to culture and history that is engrained into their social consciousness and personality since youth. When workers are feeling detached, or demanding it and the quality of interpersonal care is affected, the long-term consequences include smiting the cultural heritage the individual holds vital to their identity. The logical outcome is that this damaged pride and also the rough quality of care will act as a future deterrent for seeking adequate or preventative health care. The interviews conducted with immigrants and their health care workers reinforces that the economic demand model and the supply model can be affected negatively when using it as a model for analysis about what drives individuals in immigrant groups to avoid health care provision. Even as the prices rise, the supply of health care remains stagnant and does not fit the usual economic models of other for-profit businesses that attempt to limit supply in the face of radical price reductions or increase supply at a time when prices are higher. It seems to act as only a baseline of comparison that considers the economic and utility factors of those who are in higher-paying career positions and have access to the disposable funds to seek health care treatment and prevent long-term illnesses. For the contractor, this data is significant as it will impact the quality and integrity of the employment relationship as well as the social consciousness necessary for leadership in government to establish health care systems that are of benefit to minority immigrant groups. In relation to health care expenditures, comparing domestic natural citizens with immigrants, non-citizens spend 50 percent less than U.S. natives on health care (Stimpson, Wilson & Eschbach, 2010). This is a significant difference and it is further supported by quantitative data that from an analysis of over 200,000 native citizens and non-citizens. If the demand model is used as an appropriate analysis, this high volume of those not spending on health care would be eroded as a factor and considered a stagnant variable against pricing. However, it was previously established that immigrants typically do not seek health care due to transportation limitations, wage restrictions, poor job benefits packages and also the prejudices that erode the quality of health care in the system. Thus, utility in relation to rational self-interest, would be the most appropriate model for analysis since it involves personal and cultural factors that drive decision-making for considering a health care purchase. Consider another example of the socio-cultural status of immigrants versus citizens. A recent outbreak of carbon monoxide poisoning in California led to a study of 259 patients diagnosed with CO poisoning between December 15 and December 24, 2006. The study involved 86 different households. Fifty eight percent of those diagnosed were from immigrant households (Gulati, Kwan-Gett, Hampson, Baer & Shusterman, 2009). Of the 58 percent, 82 percent of the CO poisoning stemmed from charcoal use as an internal fuel source (Gulati et al). These high instances of individuals using charcoal in household furnaces again reinforces the complexity of immigrant household lifestyle needs that impacts this group differently from the predominant norm used to justify most demand and supply models. It is clearly lifestyle-related as to why most of the individuals exposed to carbon monoxide fumes hailed from immigrant households considering their wages are inferior to many native citizen groups and they are forced to use antiquated fuel sources for basic survival needs. Abraham Maslow developed a hierarchy of needs in which it is supposed that basic physiological needs must be met adequately, along with safety, in order to find higher self-enlightenment in relation to becoming a whole and satisfied person psychologically (Morris & Maisto, 2005). This tiered hierarchy suggests that after security needs are met, such as shelter, belonging and self-esteem development can be actualized, but only if the first lower needs are met sufficiently. This model reinforces why utility is a most appropriate measurement for determining the disparity between health care provision for immigrant groups and their demand for the services even though they are in adequate supply in most regions of the United States. There are genuine lifestyle restraints that impact the most basic survival and security needs, coupled with a social attitude within the health care network that considers their needs to be inferior to those in a more affluent environment or with adequate health insurance. The system, itself, seems to create a rift in the tier of belonging on Maslow’s hierarchical model that further breaks down the social identity of the individual and impacts their desire to seek appropriate treatment when needed or when preventative concerns are transparent. “Communication between providers and patients will influence patients’ understanding of their care plans, motivation for adhering to treatment regimens, and comfort in asking questions” (Mullins, Onukwugha, Cooke, Hussain & Baquet, 2009, p.2101). Further, many immigrants do not speak adequate English or any English whatsoever, creating further rifts between the demand for health care services versus their availability. There are few translators that operate in the system, which is logical considering the health care budgets and current state of the national economy, however it is a detriment to the social needs of the individual at the psychological level as identified by Maslow (and other social scientists). Brown (2009, p.146) further identifies that the status of the immigrant or refugee “profoundly shapes individuals’ views and expectations of their host government as well as interactions with medical, educational and social service institutions they encounter”. Failure to seek adequate health care is then a two-edged sword that cannot be explained through economic demand and supply models. Having a profound impact on this type of health-related decision-making then is a utility issue, as previous surmised, that is created by the social interaction with their home, work, political or interpersonal environments. This data is significant for the contractor as it will directly impact the relationship between worker and leadership. Micro-economic factors directly related to immigrant lifestyle determine whether their national identity is validated or whether they have a negative relationship vis-a-vis the state legislators or health care providers involved with improving the quality or supply of health care provision. Consider Mexico as an example of this. Quantitative statistics indicate that in order to generate job growth in this country, it is necessary to sustain a 7.4 percent GDP growth year by year (Hazan, 2009). This is not currently feasible for the country that is experiencing declines in the stability and growth patterns of its broader macro economy. There is heavy emigration of unsatisfied workers to the North into the United States that is produced by this low level of job creation, government intervention, and health and education (Hazan). As identified, this already strains the economy in poor regions of the U.S. where unemployment rates are already higher than would be found in a healthier and growing economy. Emigrants from Mexico are already burdened by domestic inferiorities related to employment and health care and emigration does not lessen these factors when they are surrounded by high volume health care supply amidst social prejudices by the caretakers themselves. Recommendations Based on the data presented for analysis, it is recommended that a cultural approach is taken by government legislators or those working within the health care system to identify the socio-cultural disparities that lead to poor performance in quality as well as the demand for health care services. There is also a widespread social view in the U.S. that immigrants are overall causing significant harm to the domestic economy backed by ongoing racism against this group (Davies, 2009). Individuals seeking an economic answer for disparities in health care would be hard-pressed to justify their assumptions or findings in a study considering that there is a high volume of social pride in many of these groups and a strong sense of affiliation collectively that impact their decision-making about health care attainment. Breaking down age-old barriers that have been put in place by years of social conditioning is something best conducted using a utility analysis related to socio-cultural background rather than pricing issues related to supply and demand. Thus, the contractor should explore the environment and the family structure of immigrant groups prior to launching a new health care support program or simply supplying health care needs in a traditional clinic or hospital environment. Further, the health care system is different than traditional businesses in the monopolistic competition model of microeconomics. Pricing radically impacts service production and there are spikes associated with supply based on consumer demand that are more predictable than in an environment that caters to, sometimes, crisis scenarios from immigrants working in dangerous low-paying job positions. Data should be collected from reputable hospitals that regularly service immigrant health care needs across the country to identify where spikes in treatment or in demand are noticeable and attempt to locate a correlation with family structure or country of origin to identify a potential cultural connection. The contractor may discover that certain ethnic groups are more apt to have higher demand for services even in the face of a system that often provided prejudicial treatment or inferior care due to personal caregiver bias. This may improve the overall knowledge of what drives demand in the immigrant populations to assist in creating mobile health care services or working with clients to make the system more appealing. Conclusion It is likely why it is difficult to determine whether immigrants could be served better in relation to health care provision when individuals use the economic supply and demand models. In many domestic citizen groups, the ability to seek preventative treatment is a lifestyle must and easily attainable by certain lifestyle factors associated with job and wages. Therefore, little is put into the decision-making and it is a rather automatic response, much like a consumer convenience purchase. However, this analysis identified that immigrants face so many large-scale detriments that utility is the only viable method for understanding, since it leads the researcher to the environment and lifestyle rather than just pricing concerns that seem to be secondary in the immigrant groups. 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