US Health Care System for the Mentally and Physically Disabled - Research Paper Example

US Health care system for the mentally and physically disabled The mentally and physically disabled are one of the most vulnerable sections of the society, worldwide. ‘To be vulnerable is to be susceptible to harm and neglect, that is, acts of commission or omission on the part of others that can wound...to be vulnerable is to be in position of being hurt or ignored, as well as helped, by others” (Aday, 2001, 1). In this modern globalised era of fragmented families, the concept of ‘common good’ has taken a back seat in the American society, to be replaced by ‘individualism’. In today’s nuclear families, that lack communal feelings, so prevalent in American societies during the pre-World wars days, it has become imperative that the US government now take special initiative to provide specialized care for the mentally and physically disabled population. It was for this very reason, with specific aims to protect the vulnerable sections of the society that the US federal government came up with the idea of Medicare and Medicaid, which are two “federal-state health financing program for the poor” (Medicaid Managed Care Serving the Disabled Challenges State Programs, 1996, 14). The Medicare right from its conception is a US government sponsored health insurance program that bears the medical expenses of the elderly and the disabled section of the American population. Medicaid, though originally aimed to help the low income families in US, now directs “more attention to using managed care for another group of Medicaid beneficiaries—those who are disabled. These individuals constitute about 15 percent of all Medicaid beneficiaries, but because many of them have a heavy need for specialized medical services, they account for over one-third of all Medicaid expenditures” (ibid). In this article we will take a close look at this US Health care system for the mentally and physically disabled, and study the characteristics and health concerns of this disabled population, while exploring the quality, access and cost, and also estimating the future of health services delivery to this particular section of the US population.  Characteristics and health concerns of the mentally and physically disabled population: Health as defined by WHO is a “state of complete physical, mental, and social well being” (WHO, 2010). To define ‘mental and physical disability’, we can say that it is "a physical or mental impairment that substantially limits one or more of the individual’s major life activities, such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working" (Americans with Disabilities Act, 1990). Thus, physical and mental disabilities are pertaining to those people who suffer from certain impairments that interfere with their normal daily functioning. Under this ADA act, it is illegal to show any sort of bias against people with mental and physical disabilities “in employment, public services and transportation and places of public accommodation” (United Nations, 2004). According to the US Census Bureau, people with disabilities can be categorized/ characterized as: Having a reported mental, physical, sensory, and self care disability (pertaining to people who 15 years and older) Reported disability in going out of the home atmosphere (pertaining to people who are 16 years and above) Employment disability of some sort in the age group 16 -64 years (U.S. Census, 2005). According to the same census it has been estimated that around 19.2% (48.9 million people) of the US population come under the category of being mentally and physically disabled, with every signs of the numbers increasing rapidly, owing to various social and environmental factors, within the next decade (ibid). From the above discussion it is quite clear that there are certain aspects of health issues that concern this section of the population. Long term diseases like cancer, various cardiovascular diseases and gastrointestinal disorders, that often make people physically disabled, are more than not found to be associated with severe mental depression and anxiety disorder. Physically disabled people are often found to suffer from personality disorders and severe psychoneuroses (Shaffer, Nussbaum, & Little, 1972). People with mental disabilities often show generic problems like heart malfunctioning (as in Down’s syndrome), however it is mostly the lack of proper care and medical services, owing to communication difficulties from the patient’s end, that forms a major problem in the area of health concern for such people. The main issues of health pertaining to this group are sensory problems (lack of or improper vision and hearing), obesity problems, epileptic problems, and dental problems, and also low life expectancies. Quality, access, and cost of providing medical services for this section of the population: Researches have shown that almost 6% of the US population are afflicted with some sort of mental disabilities, like bipolar disorder, depression or schizophrenia, while 10% of US children show severe depression, to conduct problems, to substance abuse disorders (Mark, et al, 2007). Medicaid is the largest service provider for patients suffering from both mental and physical disabilities of any form. According to US Census survey in 2006, amongst the disabled population that comprises of around 25 million US citizens, around 20% are covered by Medicaid, 3% by Medicare and Medicaid both, 15% are uninsured and 53% come under private insurances (Crowley, 2006). Since those with disabilities have a high rate of unemployment, they do not get the benefit of employer sponsored insurance coverage, while the private insurances are mostly aimed for the general, healthy people and rarely do they accommodate people with disabilities. So in spite of the ADA act which makes it illegal to discriminate, we find bias when it comes to the making of health insurances for the mentally and physically disabled people, in the private insurance market (How accessible is individual health insurance for consumers in less-than-perfect health?, 2001). There are a variety of public support programs for the disabled in US, but often the complexities of these programs in their approach processes makes it difficult for these people to find the best suitable program. One such program known as the SSDI, or Social Security Disability Insurance, is quite beneficial for the workers who all develop mental or physical disabilities while working, and it makes them eligible for Medicare. To become eligible for Medicare, one must be below 65 years of age. The Social Security Administration (SSA) will have to determine whether the applicant really has disabilities and these are based on certain stringent conditions, and all requirements must be met. It must be determined whether the disability is of a permanent a or a long lasting kind (to determine this the applicant will have to wait for 5 months before he starts receiving the SSDI; and only after 24 months from the date of receiving the SSDI, will the applicant become eligible to receive Medicare); and the SSA will also determine whether the disabled adult cannot work owing to his disabilities. However, those with disabilities right from childhood (Disabled Adult Children or DAC) are eligible for Medicaid, but have to go through the 24 months waiting period once they turn 18 years of age. Here again, we find a flaw where we see that people with terminal illnesses that often lead to physical disabilities like HIV, multiple sclerosis, or even Parkinson’s disease, do not come under the Medicare until they are in the advanced stage of their disease. Since these people would find it almost impossible to acquire private insurances, it is a bias on the part of the US Health care system on a this section of the mentally and physically disabled population. Medicare that pays for health facilities of the disabled population, offer benefits like, regular visits to the doctor, hospital care charges, prosthetics and other durable equipments necessary for medical purposes, gives easy access to specialized care, and also offers benefits for all prescribed medicines. However, its drawbacks include that it is not beneficial for the patients that are homebound (that is, those who cannot go out owing to their disabilities); and it also does not cover dental facilities, routine vision and hearing checkups and related aid equipments; does not support long term medical facilities; and gives limited coverage to the mentally disabled people (mentally retarded). Medicaid applicants must meet the same requirements for the SSI approval, as the Medicare benefit program, and 78% people with disabilities become eligible under the Medicaid program. Often the states also extend help to those with disabilities coming under the poverty level, and also extend their coverage through various other available options. The Medicaid benefit program, though does not offer direct cash to its beneficiaries, operates in a manner where it makes direct payments to the health care providers used by the patient. It offers two kinds to services, mandatory and optional. Under the mandatory programs, inpatient / outpatient hospital care; physician services; all kinds of pathological testing services including x-ray; screening, diagnostic tests (regular and periodic); and EPSDT services for patients under the age of 21; and also provides for home health care services (unlike Medicaid). Optional services include prescribed medicines, dental services, prosthetic equipments and also vision and hearing aid equipments, intermediate Care Facilities for those with mental disabilities, rehabilitating services, and private nursing services. In the graph given below we can see that under the Medicaid program, the disabled section of the population gets the maximum benefit (42% of the total expenditure on those enrolled under Medicaid) out of it, in terms of annual expenditure. Fig A: Source- Kaiser Family Foundation, June 2010. In the above graph that shows $300 billion spent on enrollees, federal spending was 57 percent, while $142.6 billion or 43 percent represented State spending. “Per-enrollee spending for non-disabled children ($2,435) and adults ($3,586) was much lower than that for aged ($14,058) and disabled beneficiaries ($14,858), reflecting the differing health status of these groups” (2008 Actuarial report, Department of Health & Human Services). Thus, we find Medicaid forms a major benefit program that provides quality health care services for the disabled section, amongst the US population. Though the application process for this benefit program is definitely tedious and a long drawn one, once a person comes under it he is more or less covered for all possible medical services necessary for his upkeep. It is a far better option than the Medicare benefit program; since the former allows for home health services for those who cannot come out of their homes yet need nursing care facilities. For the majority of the people classified as mentally disabled, and also as regards to some of the physically disable people, it is not possible for them to come out of the home without any assistance. Medicaid offers benefits for such people, while also offering benefits for dental care, eyes and ears checkups, and prosthetic devices to facilitate the sensory powers of these organs (these are general health problem for almost all disabled people, and it is unfortunate that Medicare does not cover them). However, for patients availing community based services, the benefits have been made optional for them. This is considered to be an institutional bias made by the Medicaid health service program that gives preferences for nursing home stays, over community based services. The future of health services delivery to that population: At present the Medicaid services, with some flaws, more or less covers the health services necessary for the disabled American population. However, it is necessary that in near future the government expands its scope by focusing on areas that take into account the growing population of this section of the population, and also take into consideration the aging of the now young group of the mentally and physically disabled. With rising health care costs and keeping in view the long term care necessary for the disabled, the government must make the necessary amendments so that the benefit programs remain suitable with the changing requirements. It must also bring in necessary legislations to make sure that that rapid erosion of private health insurances for the disabled population does not continue in the future. The revenue pressures faced by the US federal and state budgets must also be handled in a manner, such that these people ultimately do not lose out on the medical benefit programs, owing to revenue deficit, if any. The government must also take into account the rising number of uninsured Americans (15% in 2006) and make some provisions for the disabled amongst these group of people, so that do not remain uncared for in the distant future. References Aday, L. (2001). At risk in America: the health and health care needs of vulnerable populations in the United States. California: John Wiley and Sons, 1. 2008 Actuarial report on the financial outlook for Medicaid. (2008). Department of Health & Human Services. [ Internet Report] Accessed at,  https://www.cms.gov/ActuarialStudies/downloads/MedicaidReport2008.pdf. Crowley, J. (2006). Access to Health and Long Term services for people with Disabilities. Health Policy Institute, Georgetown University. Accessed at, http://www.kaiseredu.org/tutorials/Disabilities/disabilitiescare.ppt. How accessible is individual health insurance for consumers in less-than-perfect health? (June 2001). Kaiser Family Foundation. [Internet article] Accessed at, http://www.kff.org/insurance/upload/How-Accessible-is-Individual-Health-Insurance-for-Consumers-in-Less-Than-Perfect-Health-Executive-Summary-June-2001.pdf. Kaiser Family Foundation. (June 2010). Medicaid enrolees and expenditures by enrolment group, 2007. [Internet report] Accessed at, http://facts.kff.org/chart.aspx?ch=465 Mark, T., et al. (October 2007). ) National Expenditures for Mental Health Services and Substance Abuse Treatment. U.S. Department of Health and Human Services. [Internet report] Accessed at, http://www.samhsa.gov/spendingestimates/SAMHSAFINAL9303.pdf Medicaid Managed Care Serving the Disabled Challenges State Programs. (July 1996). Report to the Chairman and Ranking Minority Member, Subcommittee on Medicaid and Health Care for Low-Income Families, Committee on Finance, U.S. Senate. United States General Accounting Office, 14. [Internet report]  http://www.gao.gov/archive/1996/he96136.pdf. Shaffer, W., Nussbaum, K., & Little, M. (1972). MMPI profiles of disability insurance claimants. American Journal Psychiatry, 129(4).63-67. The Americans with Disabilities Act- ADA. (1990, July 26th). Public Law 336 of the 101st Congress, 42 U.S.C. 12102. United Nations. (2004). International Norms and Standards Relating To Disability- The Legislative Process. [Internet Archive] Accessed at, http://www.un.org/esa/socdev/enable/comp102.htm U.S. Census. (2005). Disability and American Families: 2000. US Census Bureau, Dept. of Commerce, Washington, DC. World Health Organization. (September 2010). Mental health: strengthening our response. [Internet fact sheet] Accessed at, http://www.who.int/mediacentre/factsheets/fs220/en/ Read More