Access To Health Care - Essay Example

of affiliation: ACCESS TO HEALTH CARE Health care system in America has realized great transformations that have not only made it more complex but also much different from what it used to be. The changes are diverse and reflect the significant shifts realized when changing from an indemnity plan, founded strongly on what the patients proposed, to a managed care scheme. The past two generations have not only realized drastic health care changes but also offered a strong foundation for the many continuing transformations experienced. How different is the health care delivery today? What factors are responsible for the changes realized? How are families affected with these changes? What can be done? What should the anticipation of American be with regard to health care future? All these are crucial questions to be handled even as American population continues to age, health care cost shoots up, treatment turns out to be expensive and the number of persons not covered in healthcare scheme grows. This work will handle these questions detailing different aspects of health care accessibility in America and the way they have transformed over the past years. While many American today may be benefiting fully from the national health care system that offers an extensive access to healthcare, it is true that a considerable percentage still find difficulties with regard to obtaining basic health care services. A research conducted by the National Healthcare Disparities Reports (NHDRs) to find out the access problems among the American showed a disproportionate representation of particular groups. Among the people less represented are ethnic minorities, particular races and individuals graded as low socioeconomic status (SES). Another report from the National Healthcare Quality and NHDR revealed that showed health care insurance as the main factor responsible for the poor quality care with regard to some core measures. This report further showed these factors as not showing any good sign of possible changes. Here, the uninsured were depicted as less likely to receive care recommendations for disease prevention that include cancer screening, counseling services on diet and exercise, dental care and flue vaccination. Additionally, this group of people could not easily get care recommendation for management of diseases like diabetes. Poor health care accessibility comes at both societal and personal cost. For instance, if persons do not get vaccinated, they may end up sickly and spread the disease to others. In such a case, the society overall disease burden shoots up in addition to the burden felt individually. Components of Health Care Access Access to health care may be better defined as “the timely use of personal health services to achieve best health outcomes. According to IOM, access to health care means having "the timely use of personal health services to achieve the best health outcomes". For one to be graded as Attaining good access to care three discrete steps are considered: 1. Getting admission into the health care system. 2. Gaining access to sites of care where patients can receive needed services. 3. Finding providers who meet the needs of individual patients and with whom patients can develop a relationship based on mutual communication and trust. Access to Health care is evaluated in numerous ways, including: Structural measures regarding the presence or absence of particular resources that hold up health care; this includes health insurance and other common source of care. Evaluations by patients on how they can access health care with fewer difficulties. Utilization analysis of the final outcome of proper access to care (this includes the successful receipt of needed services). Facilitators and Barriers to Health Care There are a number of health care barriers just like there are facilitators, some of which are discussed here. This includes health insurance, patient’s awareness of need and usual source of care (that includes having a common source of continuing care and a common primary care provider). Findings Health Insurance Health insurance assists when seeking entry into the health care program. Uninsured persons are least likely to gain medical care and thus ran the greatest risk of having poor health status. In 2004 the cost of poor health observed among the uninsured person had risen to almost $ 125 billion. (Hadley & Holahan,55). The financial burden for the uninsured was equally found to be high. Here, medical expenses were found to cause almost half of the personal bankruptcy filings. (Jacoby, et al., 22). Uninsured persons have been found to report more problems when trying to get care, and are mostly diagnosed at later stages of the disease. The sad part is that they get less remedial care. According to this study, these individuals are usually sicker when hospitalized and are succumb to death easily in the course of their stay (Hadley & Holahan, 77). The following figure shows statistical data taken between 1999 and 2009, showing People under age 65 with health insurance, by age and gender Figure 1 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS), 1999-2009. Note: NHIS respondents were questioned over health insurance coverage during an interview. Respondents were presumed as insured if they had a private health insurance, Medicaid, Medicare, a state –sponsored health plan, State Children's Health Insurance Program, military health plan and other government-sponsored health plan. Additionally, individuals were considered uninsured If their only coverage was through the Indian Health Service. Approximations are not adjusted. Generally, no significant statistical change was recorded between 1999 and 2009. In 2009, 83 percent of persons below age 65 possessed health insurance (data not shown). The period between 1999 and 2009, realized an increase in percentage of children with health insurance from 88% to 92%. This took in individuals with ages ranging from 0-17. Adults aged 18 to 44 and 45 to 64, depicted percentage decrease with those aged 18-44, dropping from 79% to 74%; and for those aged 45-64, dropping from 88% to 85%. In 2009, grownups aged 18-44 and 45-64 showed little possibility of accessing health insurance when compared to children aged 0-17. This is placed at 74% and 85%, respectively, compared with 92%. Beginning 1999 to around 2009, the proportions of males with health insurance drop off (from 83% to 81%). For the females, no statistically significant change was recorded in this period. Females depicted a higher likelihood of having health insurance than males all through this period. Additionally, in the NHDR: In 2009, Blacks falling below age 65 were more likely than Whites to miss health insurance. This trend was also true when comparing the American Indians and Alaska Natives (AI/ANs) below age 65 with the Whites. In 2009, Hispanics aged 65 and below were less likely to have health insurance when compared to non-Hispanic Whites. The proportion of persons with health insurance was considerably lower for low-income, the middle-income people and the poor when compared with the high-income people. The percentage of persons with health insurance was about 1/3 lower when comparing persons with less than a high school education and those with at least a college education. Uninsurance Long periods of uninsurance have been found to pose certain repercussions, considered serious, to the health and stability of the affected. Uninsured people will most times postpone the need to seek care and end up facing difficulties obtaining the care when they finally seek it. In fact, in some cases they are forced to bear the complete burden of the health care demands. As time goes by, the collective penalty of being uninsured compound; ensuing in a population facing particular threat for suboptimal health status and healthcare. . Figure 2 below shows People below age 65 who were uninsured all year, by age and gender, between 2002 and 2008. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2008. Note: For this evaluation, lower rates are most preferred. Generally, from 2002 to 2008, the proportion of uninsured persons below age 65 increased all the year (from 13% to 15%; data not shown). The period between 2002 and 2008, saw children aged 0-17 as being least probable to be uninsured throughout the year, while grown up aged 18-44 as the most likely to be uninsured throughout the year ( 8 percent for ages 0-17 and 21 percent for ages 18-44 in 2008 ) The period beginning 2002 to 2008, females showed the lowest probability of being uninsured throughout the year when compared to their males counterparts (in 2008, 13percent compared with 18 percent). Also, in the NHDR: In 2008, American Indians and Alaska Natives were more likely to be uninsured throughout the year when compared to Whites. Hispanics were showed a high likelihood of being uninsured throughout the year than non-Hispanic. The percentage of low-income persons and of poor people who were uninsured throughout the year was almost four times as high as that for high-income people. on the other hand the proportion of middle-income persons uninsured throughout the year was twice that depicted by high-income people. Beginning 2002 until 2008, the percentage of persons found to be uninsured throughout the year was just about thrice high for persons speaking another language at home when compared to people who speaking English at home. The following figure shows People under age 65 who were uninsured throughout the year, California, 2009 Source: University of California, Los Angeles, Center for Health Policy Research, California Health Interview Survey, 2009. Note: For this analysis, lower rates are most preferred. Data did not reflect criteria employed when seeking statistical dependability for persons speaking Chinese. The English aptitude of respondents is analyzed using the following classes: Not Well/Not At All, English Well/Very Well, and English and English Only In 2009, close to 12% of people living in California was uninsured throughout the year in the previous year (data not shown). Fluent(well or very well) English speakers living in California were about twice as likely as those speaking English only to be uninsured throughout the year in the previous year (18 percent compared with 10 percent). Persons with difficulties in speaking English (did not speak English well or did not speak English at all) showed a high likelihood of being uninsured said to be thrice those speaking English only (36% compared with 10%). Persons speaking Spanish as their preferred language were three times as likely to be uninsured as people speaking English throughout the year in the previous year (36 percent compared with 12 percent). Persons whose favorite language was Korean showed a four times likelihood to be uninsured throughout the year when compared to those speaking English as their preferred language (49% compared with 12%). When considering California, persons born outside the United States were about three times as likely as people born in America to be uninsured throughout the year in the previous year (23 percent compared with 9 percent). FINANCIAL BURDEN OF HEALTH CARE COSTS Health insurance should at all time work to protect individuals from the trouble of meeting the high health care expenses. This is not the usual case despite the presence of health insurance, as the financial load for health care can still be high and increasing (Banthin & Bernard, 125). Out-of-pocket payments and High premiums play a significant role as barriers to accessing vital medical treatment and associated preventive care (Alexander, et al., 67). One of the past research has shown uninsured families as being able to afford to pay for only 12 percent of hospitalizations cases they experience (HHS, 34). One method used to assess the extent of financial load has been to determine the proportion of family income used up on a family's out-of-pocket medical expenses and health insurance premium. The figure below shows People under age 65 whose family's out-of-pocket medical expenses and health insurance premium were greater than 10% of total family income, by gender, insurance, activity limitation and age, 2008 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2008. Note: For this analysis, lower rates are most preferred. Total financial load includes out-of-pocket costs for health care services and premiums. Generally, in 2008, almost 17 percent of persons aged 65 and below had out-of-pocket medical, health insurance premium and expenses that were greater than 10 percent of entire family income (data not shown). The percentage of persons with 65 or less years, whose family's out-of-pocket medical expenses and health insurance premium were greater than 10 percent of the entire family proceedings was about three times as high for persons with private non-group insurance in comparison to persons having private employer-driven insurance (49 percent compared with 17 percent). No statistically significant difference was realized between publicly insured persons and persons with employer-driven insurance. Females were more likely than males to have family's health insurance premium and out-of-pocket medical expenses. These were more than 10 percent the entire family proceedings (18 percent compared with percent). Grownups of ages 45 to about 64 showed greater likelihood of having out-of-pocket medical expenses and family health insurance that were greater than 10 percent the cumulative family income when compared with persons aged 0-17. Persons identified with activity limitations (both complex activity limitations and basic limitations) showed a greater likelihood to have out of pocket medical expenses and health insurance premium that were greater than 10% their entire family income when compared to people with neither type of activity limitation. Also, in the NHDR: The percentage of individuals aged 65 or below and whose family's out-of-pocket medical expenses and health insurance premium were greater than 10 percent the cumulative family proceedings was higher for whites compared with Blacks and higher for non- Hispanics compared with Hispanic Whites. The percentage of persons whose age was 65 or lower and whose family's out-of-pocket medical expenses and health insurance premium were greater than 10% the total family income exceeded that of poor individuals four times; it exceeded that of low –income people three; while for the middle –income persons it were more than twice compared to high income persons. Usual Source of Care Persons who benefit from usual source of care (a facility where one receives care regularly) experience enhanced health outcomes and lessen disparities (slighter differences between factions) (Starfield & Shi, 85) and expenses (De Maeseneer, et al., 15). A proven study suggests that the impact on quality of the combination of a usual source of care and health insurance and is additive (Phillips, et al., 34-40). Additionally, persons enjoying the benefits of a usual source of care showed a greater likelihood of receiving preventive health services (Ettner, 56). Specific Source of Ongoing Care The phrase "specific source of ongoing care" is used when referring to patients who may have two or more sources of care, such as older people and women of childbearing age, who mostly have more than one physician. A particular source of ‘ongoing care’ can incorporate an urgent care/walk-in clinic, , clinic, doctor's office, hospital outpatient clinic, health center facility, , health maintenance organization/preferred provider organization, martial or other Veterans Affairs health care facility, or some other related source of care (however, hospital emergency rooms are excluded). The figure below shows People with a specific source of ongoing care, by age and gender, 1999-2009 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1999-2009. Note: analyzed figures are not age adjusted. Emergency room in hospital is not considered a specific source of primary care. Generally, 86 percent of persons had a particular supply of ongoing care in the year 2009 (data not shown). In 2009, persons aged 65 and over possessed a greater chance to have a particular source of ongoing care (97 percent), while persons aged 18-44 were least expected to posses particular source of ongoing care (74 percent). Females unlike their men counterparts had a higher likelihood to have a specific source of ongoing care beginning 1999 to2009. Also, in the NHDR: In 2009, the proportion of persons with a particular source of ongoing care was higher for Whites than Blacks and AI/ANs, and was considerably higher for non-Hispanics whites than for Hispanic. In 2009, the proportion of persons with a particular source of ongoing care was considerably higher for high income persons than for poor and low-income persons. In 2009, the proportion of persons with a particular source of ongoing care was higher for people with at least a collage education than for persons with a high school education or less. Usual Primary Care Provider Accessibility of a usual primary care giver (a nurse or doctor from whom a person frequently receives care) is linked to patients' greater belief in their provider and with excellent giver-patient communication. These features boost the possibility that patients will get suitable care. By a long in-depth study of the patients' diverse health care requirements, a customary primary care giver can manage care (e.g., visits to specialists) to meet patients requirements in a better manner. Having a usual primary care giver correlates with advancement of a higher quality care (Parchman & Burge, 120; Inkelas, et al., 66). An individual is determined to aces a primary care giver if his or her accustomed source of care location was either a hospital or physician's office (location not including an emergency room), and he or she mentioned going to this accustomed source of care when facing a new health problems, seeking preventive health services, or following a physician referrals.   The Figure below data on People with a usual primary care provider, by age and insurance, 2002-2008 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2008. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2008. Note: A customary primary care giver is meant to mean the source of care that an individual frequently visits when faced with new health problems, seeking preventive health care, and also receive referrals to related health professionals. Generally, in 2008, close to 76 percent of people enjoyed primary care provider (data not shown). People aged 18 to 44 were least expected to access a common primary care giver, while people aged 65 and above were much expected to have access to a common primary care giver (61% and 90%, respectively. Uninsured person’s ages 0-64 had low chance of having a common primary care giver compared to persons with public or private insurance (43 percent compared with 79 percent and 81percent, in that order). No statistically significant differences were identified between persons with public insurance and persons with private insurance in the proportion with a common primary care giver. Also, in the NHDR: In 2008, whites were more likely than Blacks and Asians to have a customary primary care giver. The proportion of persons with a common primary care provider was also notably lower for Hispanics when compared to the non-Hispanic Whites. Middle-income people, low-income people, and poor people were notably less expected than high-income populace to have a common primary care giver. With the recent passage into law of the Obamacare, much is expected with regard to individual’s access of the health care. This act has provisions that seek to assure every American citizen regardless of their racial background, economic and social standing, gender and age, an affordable health care (Newsmax, 12). This act further seeks to reduce and ultimately remove the health care inequalities among American citizens, especially the minority groups. The Obama care act seeks to propagate the following: 1. The Individual Mandate 2. Health Insurance Exchanges 3. Doctor Shortages 4. Medicare Changes 5. Independent Payment Advisory Board Work Cited Alexander GC, Casalino LP, Meltzer DO. Patient-physician communication about out-of-pocket costs. JAMA 2003;290(7):953-8. Banthin JS, Bernard DM. Changes in financial burdens for health care: national estimates for the population younger than 65 years, 1996 to 2003. JAMA 2006;296(22):2712-9. De Maeseneer J, De Prins L, Gosset C, et al. 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