Universal healthcare - Essay Example

Universal Healthcare Border s have the highest concentration of Mexican-origin people. The concentration of immigrants in the border has unique health and economic implications due to the vital role they have in US society, contributing both to the economy and diversity of the USA. Despite their important role, they disproportionately lack health insurance, and receive fewer health care services than US-born citizens. This lack of insurance puts a burden on the nation's economy, and their health status deteriorates as they become more prone to chronic health conditions, and their complications due to lack of primary medical attention. Introduction According to the US Census Bureau (2000), the Latino population increased by 57.9 percent since 1990. In 2000, Latinos comprise 12.5 percent of the overall population of the USA, and are the fastest growing minority group, among which the Mexican-origin population makes up about 66 percent. Border States have the highest concentration of Mexican-origin people within their overall Latino population because they contain significant points of entry. The largest Latino populations (more than one million) are concentrated in California, Texas, Illinois, Florida and Arizona. Of these, Arizona has the highest percentage of Latinos of Mexican-origin (82.2 percent). According to Burkholder and a report by the Kaiser Commission on Medicaid and the Uninsured (2000), Mexicans come to Arizona for work. Compared to other immigrants they tend to be younger, have lower education, lower wages, larger families, lower rates of citizenship, and have lived less time in the USA. Undocumented immigrants are a small yet important group within the immigrant population. Currently, there are an estimated 5 million undocumented immigrants in the USA, with half of them being from Mexico. The largest portion of the undocumented population is located in the Southwest. In 1998, it was estimated that about 20 percent of immigrants in the country were undocumented immigrants (Kaiser commission on Medicaid and the Uninsured, 2000) Since the establishment of an Office of Minority Health, following the creation of a Task Force on Black and Minority Health in 1984, considerable funds have been devoted to further studies with the aim of reducing health disparities among racial and ethnic groups, however, those disparities still persist (Weinick and Krauss, 2000; Weinick et al., 2000). Barriers to health care access Sociocultural basis of health and disease There is no question that income, educational attainment, and poverty levels are closely linked to health, health care access, and health insurance and that cultural values, beliefs, and attitudes influence help-seeking behaviors (Flores et al., 2002). De la Torre and Estrada (2001) state that health does not exist in isolation from socioeconomic factors. In fact, socioeconomic status profoundly influences health status both positively and negatively, as has been shown in many studies (Sorlie et al., 1995; Kaplan and Keil, 1993; Feinstein, 1993). Several socioeconomic characteristics of the Mexican-origin population have harmful effects on both its general health care behaviors and its general health status. Low income, substandard housing, inadequate or unsanitary living facilities, limited formal education, ethnic segregation and discrimination, poor nutrition, and stress can and do affect the health of Mexican Americans in a number of ways (Sorlie et al., 1995; Kaplan and Keil, 1993; Feinstein, 1993). Mexican Americans as a group have lower incomes, lower educational attainment, and higher poverty rates than non-Latino whites (Feinstein, 1993). Another problem is English language fluency. An extensive body of literature indicates that English skills and proficiency play an important role in the educational and economic success of Mexican-origin people (Feinstein, 1993). Language is also an important barrier to health care access and quality, because of the difficulty in communicating with the health care providers (Schur and Albers, 1996; Woloshin et al., 1995; Solis et al., 1990). The level of education influences the occupational status of the Mexican-origin population, which in turn predicts whether or not they will rely on public or private health care services. Education also influences the extent to which individuals are aware of risky behaviors or of predisposing conditions that may influence their health, leading to decreased awareness of health promotion and disease prevention activities (Feinstein, 1993). Issues related to language limitations, discrimination, misinformation, and fear are also factors that make immigrants' access to care difficult. Other more tangible, barriers are the great proportions of uninsured immigrants, enrollment obstacles, and documentation requirements (Kaiser Commission on Medicaid and the Uninsured, 2000). These barriers limit utilization of healthcare and prescription medications, and contribute to institutionalized racism and discrimination (Flores et al., 2002). Finally, they increase the probability that an individual will choose alternative forms of health care, which may be ineffective or even harmful (Flores et al., 2002; Burciaga Valdez, 1993). Among the factors influencing health care access for this group, in particular, those we believe have the greatest impact are health insurance coverage, or financial access and access to culturally, and linguistically competent health professionals in a timely and regular manner (Flores et al., 2002). Health care access is important because it influences health status and quality of life. According to Williams and Torrens (1984, p. 420), "poor access may be reflected in delayed care seeking, absence of preventive care, and low patient satisfaction." The Commonwealth Fund 2001 and Health Care Quality Survey (Commonwealth Fund, 2002) found that 22 percent of Latinos, with a higher proportion of Mexicans, rate their health as fair or poor, 33 percent of Latinos report having a problem of understanding or communicating with their doctor, with greater difficulty reported by those who primarily speak Spanish. The uninsured There are about 44 million uninsured in the USA, among which immigrants constitute 20 percent (Kaiser Commission on Medicaid and the Uninsured, 2000). The likelihood of being uninsured is almost doubled for low-income non-citizens compared to low-income citizens. Of the 8.3 million low-income non-citizens, over 58 percent had no health insurance in 1998, and only 15 percent received Medicaid. In contrast, about 30 percent of low-income citizens were uninsured and almost 30 percent had Medicaid (Kaiser Commission on Medicaid and the Uninsured, 2000). Over half of Mexican immigrants are uninsured (Kaiser Commission on Medicaid and the Uninsured, 2000). The medical literature confirms that people who lack insurance experience poorer health outcomes such as preventable disease, more severe disease, late diagnosis, and even premature death (Stagg, 2000). For example, the incidence of diabetes-related end-stage renal disease in the Latino population is six times greater than in the non-Latino white population. Uninsured Latino women with breast cancer are more than twice as likely to be diagnosed at a later stage than non-Latino women. And uninsured Latino children with asthma are six times more likely not to receive standard medical treatment (Stagg, 2000; Granados et al., 2001; Flores et al., 2002). It is often more expensive to provide medical treatment for the uninsured than it is to provide preventive acute and chronic care on a regular basis (Stagg, 2000). Most Americans obtain health insurance through the work place. Employers, particularly large firms, including the government, typically provide health insurance to an individual and his or her family members as part of their benefits package. This type of coverage is known as a voluntary system of health insurance. An individual employee either shares the health insurance premium with the employer or is provided with coverage at no cost. Some employers, typically small businesses in competitive markets, do not provide health insurance to their employees. Employment in small firms and in low-wage sectors of the economy that do not offer fringe benefits is one of the most important reasons for the difference in coverage between Latinos and the general population (Kaiser Commission on Medicaid and the Uninsured, 2000). Barriers to public insurance Three major federal health programs target people who are medically at risk, disabled or elderly. These are Medicaid, supplemental security income (SSI), and Medicare. SSI is a "nationwide federal assistance program administered by the Social Security Administration that guarantees a minimum level of income for needy aged, blind, or disabled individuals." Medicare is a federal public health insurance program that was created primarily for the elderly. It covers people who are 65 years of age or older, individuals with permanent kidney failure and individuals with certain disabilities. Unlike Medicaid, there is no income or eligibility means test for this program. Entitlement is based on employee payment into the Medicare trust. As defined by the Health Care Financing Administration: There are two groups of barriers in accessing Medicaid: those related to immigrant status and those related to vulnerable and low-income population status such as culture and language, inaccessible locations for completing complex application procedures, and inability to pay for health care services (Center for Health Services Research and Policy, George Washington University). Medicaid and Medicare covered only 13 percent of non-citizens in 2000. As reported by the George Washington University, Center for Health Services Research and Policy, PRWORA also represents a shift in immigration policy from the federal to the state level. State officials have discretion to determine which types of immigrants will receive which kinds of public benefits. After welfare reform, only California opted to include immigrants in all its health programs, including Medicaid, even though the state receives no federal funds to do so. Immigrants appear to have shifted care seeking increasingly toward safety net providers that can offer free or reduced-price care. Other trends have been to delay or avoid medical care and some times to turn to alternative, sometimes underground, health care providers for services (Kaiser Commission on Medicaid and the Uninsured, 2001). Safety net providers typically include public hospitals, non-profit charitable hospitals, local health departments, community health centers, free clinics, and similar facilities. They serve a disproportionate share of Medicaid clients and provide uncompensated care for uninsured people, using public and private grants and other revenue sources to underwrite the care. Because of their locations in high immigrant areas and commitment to serve needy immigrants many safety net providers have developed special capabilities such as bilingual staff, interpreter services and special culturally adapted programs (Kaiser Commission on Medicaid and the Uninsured, 2001). By this, these providers could be more susceptible to reductions in Medicaid coverage or increases in the demand for uncompensated care by immigrants, putting at risk their financial viability. However, in areas of recent migration, health care institutions were not prepared to serve this new population and those cultural or linguistic programs are very limited or at an initial process of development (Kaiser Commission on Medicaid and the Uninsured, 2001). Much of the Mexican-origin population falls within the category of the working poor. This means that their incomes do not meet the FPLs required for public health insurance, but they are employed in low-wage employment sectors that do not provide health insurance. Compounding this problem, the Mexican-origin population 65 years and older has a very low rate of private health insurance coverage (immigrants with limited English language, who worked in low-paying jobs with no retirement benefits) provided through previous employment, leaving them entirely dependent on Medicare. Almost 24 percent of Latino elders live below the poverty level (Older Americans, 2001). Other barriers to health care access Many immigrants experience additional barriers, among them the most reported one was the rising cost of medicine compared to the declining family income and wages. Cultural differences Cultural and language barriers hinder communication and may produce confusion about diagnosis and treatment. This happens when services are not culturally competent. The belief that American citizens and some immigrant groups receive preferential treatment in getting private or public coverage may affect the trust in the system and consequently negatively influence the health seeking behaviors (Kaiser Commission on Medicaid and the Uninsured, 2001). A Kaiser Family Foundation (1999) study report found that fewer Latinos trust their doctors always, or most of the time, and more Latinos believe that the healthcare system treats patients unfairly based on how well they speak English than Whites or African Americans. For immigrants who are insured, confusion about navigating the managed care system, lack of awareness and understanding of public programs like Medicaid and state children health programs (SCHIP), difficulty in understanding complex eligibility rules, enrollment procedures, benefits and limitations of public coverage all constitute major barriers in accessing the health care system. Feinberg et al. (2002) found that English language proficiency has a significant effect on enrollment and perceived barriers to Medicaid enrollment among eligible children. In addition, fear that seeking help from a government program will jeopardize the opportunity to become a citizen, and frustration that despite working and paying taxes, many are unable to get employer or Medicaid coverage, make the disparities among Latino immigrants and citizens more evident, and give them a connotation of inequality. Under-representation of minority health care professionals De la Torre and Estrada (2001) suggest that the role of minority populations will continue to lag behind as long as they continue to be underrepresented in the health professions. Latino physicians, like other minority physicians, provide greater access to care to Latinos and minorities. Not only do they locate their practices where there are more Latino residents, but they also serve more Latino patients relative to their non-Latino physician counterparts. Conclusions and recommendations Unmet health needs describe the extent to which existing health problems go unaddressed. The presence of unmet health needs can indicate barriers to care such as, limited availability of providers, or other problems necessitating health policy interventions (Newacheck et al., 2000). Comprehensive and culturally competent service, as well as high quality medical care can make the difference in improving the access of Latinos to medical care, thus the importance of diversity in the health care setting, as expressed by diverse groups, among them the Committee on Pediatric Work Force from the American Academy of Pediatrics (2000). Some communities have made innovative attempts to improve services for immigrants. For example, Medicaid managed care contracts in New York, added requirements for language accessibility; improving access to preventive services for hard to reach people; developing a small insurance network for low-income immigrants; community service organizations partnering with health clinics or hospitals to improve outreach and translation services are some examples of these efforts. Other states, like Rhode Island, New Jersey, and California, cover all the eligible for Medicaid populations, independent of immigration status. Arizona is looking into the feasibility of implementing an employer-sponsored insurance pilot program. The Arizona Medicaid program aims to reduce the uninsured by 2 percent. It is well known that it is less expensive to provide preventive and primary care, than to treat full blown diseases and complications, in the emergency room. There is some point in the system where the poor, the uninsured, and documented and undocumented immigrants will access the web, and that is the point where the system can break down and collapse. Providing more financial support to safety net providers that carry the burden of the increasing amount of uninsured is important, but it is also important to adopt policies that ensure that immigrants that come to this country to work, regardless of their immigration status, are provided with health insurance by the employer. As Latinos are the largest minority group in the USA, it will become increasingly difficult for administrators to argue that resources should not be redistributed in a manner that responds to the needs of this growing taxpaying constituency. Works Cited Blanton, M.L., Hudmar, J. (2001), "Untangling the web: race/ethnicity, immigration, and the nation's health", Am. J. Public Health, editorial, Vol. 91 No.11, pp.1736-7. Brach, C. 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