Access to Healthcare - Research Proposal Example

School: ACCESS TO HEALTHCARE Lecturer: ACCESS TO HEALTHCARE COMPONENT 3 Revised problem ment The rightto healthcare is enshrined in the legal books of the United States, for which reason all citizens are expected to have access to comprehensive, quality and affordable healthcare (Hendriks, 2007). This notwithstanding, there remains a very huge gap in terms of access to healthcare for most citizen (Susser, 2013). Even though several healthcare reforms have been passed over the years, none of them seem to have an outright solution to the problem of access to healthcare. Because of this, a lot more continue to be denied their basic right to healthcare as the reforms become more. When mention is made of access to healthcare, the norm has been to generalise the term to mean the reception of health services (Hendriks, 2007). The researcher sees this as a major problem that gives rise to the existing problem whereby none of the existing healthcare reforms seem to be solving the problem of access to health care for citizens. This is because there has not been any conscious effort aimed at finding the different variables that make up the components of access to healthcare to the ordinary American. In the opinion of Susser (2013), a refusal to distinguish between variables such as quality, affordability, coverage, and comprehensiveness remains a major limitation in the healthcare system. This position is shared by the researcher because healthcare reforms that have been used over the years only seem to tackle one of these variables at a time, thereby never solving the issue of access to healthcare in a holistic manner. Using the Patient Protection an Affordable Care Act (PPACA) passed in 2011 as an example, it would be noted that this reform focuses on coverage options (Access to Healthcare, 2014). Because of this, emphasise has been placed on increasing the number of insured American and reducing the number of insured Americans. But as this approach to access is taken from the perspective of coverage and affordability, the issues of quality and availability continues to exist. For example, under the PPACA, the problem of access to affordable care will be exacerbated by limited community based resources that provide preventive services, primary care access and ongoing care for patients with chronic conditions. As the number of insured citizens also increase, no one really seem to be thinking about how to make health facilities that are equipped with the right infrastructure and personnel to them. In the long run, access to healthcare services in the U.S. becomes regarded as unreliable and prohibits people from receiving appropriate and timely care they need. The problem of comprehensive outlook to the issue of access to healthcare therefore remains a major challenge for the U.S. healthcare system. As 32 million Americans become covered under insurance for the first time in 2014 (About the Law, 2014), the question of how these people can have access to timely use of personal health services to achieve best outcomes become unanswered. Similarly, there is the issue of one’s’ ability to gain entry into the healthcare system; access a healthcare location where needed services are provided; and finding a healthcare provider with whom the patient can communicate and trust. Expanded literature review Components of Access to Healthcare Searching through literature, there were four major aspects or components of access to healthcare that were identified. Each of these must be satisfied in a perfect manner to reason of a comprehensive access to healthcare. The various components, as presented by various researchers and writers have been presented as follows. Comprehensive Care According to Ezer (2013), the kind of healthcare offered to citizens must be one that covers almost all health and disease areas as and when a patient has need of those aspects of need. What this means is that in a healthcare system where some forms of health problems and diseases are not covered as part of the system, one cannot really talk about comprehensive access to healthcare. Barlow (2009) lamented about how existing and old healthcare reforms have always eliminated very crucial parts of health challenges and diseases that face people in most of the healthcare policies. Using the case of the Affordable Care Act, Leonard (2014) noted that “even though dental decay is the most common disease affecting children in the United States, even more than asthma, millions of people age 19 and younger wont have dental coverage in the coming years.” Such has been the problem with most health reforms, claiming to bring accessibility. In such situations, even though there may be provisions made for other issues such as affordability and insurance, the absence of such services under a free or affordable scheme cannot guarantee comprehensive care. Ezer (2013) noted however that given the current state of the global economy, to think that a country will have all health and disease areas covered in their healthcare reforms is impossible. Even though this may be a valid argument, it is always important to have priorities when setting targets for disease coverage. Barlow (2009) said that a solution to this issue is having a capitation system where patients can at least choose areas of disease they should be covered for a given period. Quality of Care Quality of care is another area that has been covered in most literature as a core component of access to healthcare. In the U.S. the debate on quality is never new. This is because the need to giving quality of care have surfaced year in and out. According to The World Health Organization (2013), most of the debate on access to healthcare has bordered on whether affordable care can be quality care. But Simmons (2013) insisted that quality is not a choice in comprehensive access to healthcare. This is because taking out the variable of quality defeats the whole notion of the health profession, which seeks to use the best and most applicable methods to ensure total wellness and wellbeing (Bond and Bond, 2004). Meanwhile, with the focus shifting away from quality, the health service cannot be considered to be the best. As the PPACA seeks to increase the number of citizens that will receive insurance, commentators have started becoming worried if the coverage can be translated into quality of care. This is because there is a school of thought that quality hardly prevails when there is quantity (Simmons, 2013). That is, when there is going to be a lot more people using the same facilities, personnel and equipment, there is the tendency that length of time, amount of resource, and depth of research done on a patient ought to be reduced in order to make up for other new entrants. It is in the light of this that The World Health Organization (2013) mentioned the solution to quality of care in the current circumstance where coverage is widening as the need to expand all other sectors of the healthcare system. Wider Coverage From the purpose of this study, coverage in health care is differentiated from comprehensive care using the denominators of people and service respectively. This means that when there is wider coverage to guarantee access, reference is being made to the need to ensure that a lot of people can get healthcare as and when they want it (Tulenko et al., 2012). Chait (2010) was said to note that in the U.S. coverage has been thought of to be what access to healthcare is all about. It is not surprising that the PPACA puts so much emphasis on coverage. Coverage is however very important and cannot be eliminated when focusing on the components of access to healthcare. As mentioned in other parts of the literature review, there are key issues that defeat the quest to achieve wider coverage. Key among these is the issue of discrimination, which when comes in despises the opportunities that some people will be allowed contact to whatever opportunities the healthcare system presents them with (Bond and Bond, 2004). But according to Chait (2010), the PPACA deserves commendation for touching on issues of discrimination on the grounds of race, ethnicity and age. However, it is important to keep searching for other means by which discrimination may exist such as income levels, gender and religion (Tulenko et al., 2012). It is also important to be weary of the fact that discrimination do not only happen with insurance services but also with most other point of service provisions given to citizens. Affordability There is the final issue of affordability, which touches on the purchasing power of citizens to access care. This is another area that the PPACA focuses on and thus Affordable Care Act. According to Chait (2010), affordability forms a crucial part of access to healthcare because without the economic means, a person may be limited in coming into contact with any service, whether the service is quality or comprehensively delivered (McDonough, 2011). Writing on affordability however, Viebeck (2013) said that affordability is a very relative term and this is a major challenge for the health care system. This is because when health services are pegged to modelled in such ways that can supposedly be afforded by all, the modalities used in determining prices are hardly based on what the least earner is getting. In most cases, affordability is determined from the perspective of the working class, even though there are a lot more Americans below this line (Viebeck, 2013). This thus calls for the need for more comprehensive programmes to be put in place in ensuring that the rendering of care can at least be based on the income status of a person (McDonough, 2011). Proposed purpose statement Based on the identified problem, which has to do with the unreliable access to healthcare services in the United States, the proposed study will be conducted with the purpose of understanding the service provision lapses in the health care sector that have accounted for the existing problem. With the introduction of the PPACA, the expectation was that much of the problem with access to healthcare will be bridged (Viebeck, 2013). But even as stakeholders within the health sector continue to lament on lack of access (Simmons, 2013), the researcher will also be concerned with using the study to identify alternative people centred solutions to the problem of access to healthcare. Already, the fact that the registration of 32 million Americans for the first as part of the PPACA in 2014 has been criticised as not being the solution to access (About the Law, 2014), it is important that this study will have a more people focused approached to accessibility to healthcare. By people focused approach, reference is being made to using the purpose of the study to understanding the personal factors that inhibit citizens from accessing healthcare. In the long run, it is expected that the study will be a solution based study that does not only explore what the problems are but also identifies specific interventions to the existing problems. Research questions To put the purpose of the study in a more practical form to make the collection of realistic data possible, the following research questions will be asked. 1. What variables make up the components of access to healthcare in the U.S.? 2. Does increase in health insurance coverage solve the problem of access to health care? 3. What are the key challenges identified by citizens for which they are not able to access healthcare even under a state of being covered by insurance? 4. What measures need to be taken in improving access to quality and affordable healthcare? The research questions have been constructed in way that seeks to use secondary and primary data to solving the same issues of problem with access and solving the problem with access. In effect, the first two research questions will be focusing on secondary data collection, whiles the last two questions will focus on primary data collection. COMPONENT 4 Proposed research design Research strategy The proposed study shall be conducted as a quantitative study. As noted by Remenyi, Williams, Money and Swartz (1998), quantitative research seeks to systematically undertake an empirical investigation into a social phenomenon through the use of numerical indexes. This approach to data collection is well structured and involves the use of structured data. In line with this, a survey research strategy will be devised. With this research strategy, the researcher will be offered the opportunity of investing that social phenomenon over a very wide research setting by using a representative sample of respondents. The social phenomenon being investigated is access to healthcare in the United States. The researcher has posited in the problem statement that previous and existing healthcare reforms have not tackled the issue of access to healthcare from a comprehensive perspective. The survey will thus undertake an empirical investigate to either validate the stand of the research or disprove it. There shall be two major variables to be part of the social phenomenon, which are barriers to comprehensive accessible healthcare and ways to improving lack of access. As part of the survey, the data to be collected from the respondents are going to be generalised for the collective opinion of the larger U.S. population. Population and Sample Because the findings from the survey will be generalised for the larger U.S. population, it is very important to approach the selection of respondents in a manner that can give a very fair and representative outlook of the U.S. demography. As a result, the population of the study will be in one urban centre where people belonging to different demographic backgrounds can be capture. It is expected that the population will be made up of thousands of people. It will however not be possible to capture all these people as part of the study. As a result, a sample size will be constructed using a systematic sampling technique. The reason for using a systematic sampling technique is that it will offer the researcher the opportunity of creating an ordering scheme based on the demographic differences of the U.S. Based on each demographic variable, different types of random sampling shall be taken to ensure that there is an all round sample size that gives a fair representation of U.S. citizens. The demographic variables to be considered will be based on gender, race/ethnicity, income level, age, and religion. At the end of the systematic sampling, a total of 100 respondents covering all the demographic variables will be expected to be included. Research instrument Very popular for quantitative surveys of this proposed nature is the use of a questionnaire. Through the questionnaire, various close ended questions bordering on barriers to comprehensive access to healthcare will be asked. By comprehensive access to healthcare, reference is being made to questions on comprehensive care, quality care, coverage, and affordability of healthcare. There shall also be questions covering the opinion of respondents as to the best ways they feel these barriers can be addressed from a perspective that best meet their individual differences. Close ended questions are selected so as to make the systematic analysis of data easier. Data collection procedure Data collection is proposed to take place at different times depending on the variable of respondents being dealt with. Given the fact that the researcher shall not be using a confined sample size such as a group of students or workers to who the researcher can go to at any point in time to collect the completed questionnaire, data collection for each group will be instant. This means that the researcher shall wait for respondents to finish filling the questionnaire and take them. The proposed setting to undertake this study will be health facilities, where it is hoped that people having different issues with access to healthcare can be identified and involved in the study. Ethical Consideration The study shall be conducted with the highest consideration for ethical guidelines. For example, in each of the health facilities to use, the researcher shall use a consent form to seek official permission from the authorities involved. The consent form shall outline the purpose of the study as well as the role to be played by the respondents. Measures put in place to ensure the anonymity and confidentiality of respondents shall also be made known. For example, no person data shall be collected from respondents. Privacy of respondents shall also be guaranteed by ensuring that data collected from respondents shall be handled only by the researcher and that no other third party gets access to the data collected. References About the Law (2014). Healthcare Right. Retrieved February 13, 2014, from http://www.hhs.gov/healthcare/rights/index.html Barlow, P. (2009). Health Care Is Not a Human Right. British Medical Journal 319 (7205): 321. Bond J. & Bond S. (2004). Sociology and Health Care. (Revised Ed). Texas: Churchill Livingstone. Chait, J. (2010). Obamas Moderate Health Care Plan. The New Republic. 2323(134): 14-34 Ezer T. (2013). Making laws work for patients. New York: Open Society Foundations Hendriks, A. (2007). UN Convention on the Rights of Persons with Disabilities. European Journal of Health Law 14 (3): 273–298 Leonard K. (2014). Under Obamacare, Not All Kids Will Get Dental Coverage. Accessed April 1, 2014 from http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2014/03/07/under-obamacare-not-all-kids-will-get-dental-coverage McDonough J. E. (2011). Inside National Health Reform. California: University of California Press. Remenyi, D., Williams, B., Money, A. and Swartz, E. (1998) Doing Research in Business and Management: An Introduction to Process and Method. London: Sage Simmons J. (2013). Primary Care Needs New Innovations to Meet Growing Demands. Health Leaders Media. 5(2): 13-34 Susser, M. (2013). Health as a Human Right: An Epidemiologists Perspective on the Public Health. American Journal of Public Health 83 (3): 418–426 Tulenko et al., (2012). Framework and measurement issues for monitoring entry into the health workforce. Handbook on monitoring and evaluation of human resources for health. Geneva: World Health Organization. Viebeck, E. (2013). Poll: Four in 10 think illegals are covered by Obama healthcare law. The Hill. 1331(12): 13-24 World Health Organization (2013). Aging and life course: Our aging world. Geneva: United Press Limited. Read More