The United States has one of the most modern technologies in health care services probably in the entire world. However, the United States is also criticized for having a large portion of the population who are not covered with any basic health medical cover. It is argued that most Americans do not have adequate insurance cover to cater to their medical needs. Most of the American citizens cater for their medical expenses through privately owned insurance companies while others rely on state-sponsored medical health insurance. In this arrangement, the employer caters for part of the cost while the employee is required to make monthly contributions. The state offers medical covers to its federal employees, veterans, and members of the military, and to the low-income earners. Medical insurance is directly linked to employment. This means that it is very difficult for the unemployed population to access health insurance covers. Various studies carried out on the United States health care system have revealed the failure of the United States to provide its citizens with equitable access to health care (Shi & Singh, 2011, p. 17). For this research paper, expanding access to health care has been explored.
Increasing Health care Access
Access is the ability of an individual to get medical health care. This includes when and where it may be required. From a broader perspective, access refers to the ability of getting affordable, to get, convenient, and effective medical care services when needed. It may also refer to the availability of health care to a person in society. This is in respect to whether the person is capable of using health care services or shows the acceptability of health care services to the general society. Access to care has a fundamental bearing on health and health care delivery systems. In this case, measurement of access reveals or shows the extent to which delivery of health care is viewed as being equitable. Access to health care is also associated with the quality and efficiency of the required health services. Access is an important benchmark used in the measurement of the effectiveness of the health care delivery system. In addition, access to health care is one of the major definers of health in conjunction with lifestyle, heredity factors, and environment (Shi & Singh, 2011, p. 23).
For access to health care to be termed as equitable, distribution of medical services should correspond to the patient’s perceived needs. This should also be based on the diagnosis of a qualified medical practitioner. On the other hand, access is termed to be inequitable where the medical services are distributed in relation to the ability of a client to pay for the services and social standing of the patient. Access can be measured at three distinct levels starting from the health policy, individual, and mode of delivery (Andersen, Rice & Kominski, 2007, p. 31).
Currently, in the United States, there are many barriers to health care access experienced at the individual and system levels. Most of these barriers affect the most vulnerable groups in the can society. In the United States, access is determined by three basic and interrelated factors. These include occupation, income, and race. Research indicates that people from minority groups are usually poor. Such individuals have low levels of education and often get employment in jobs that predispose them to high health risks. For example, Americans living in rural areas experience many barriers because they have low incomes. They are mostly challenged by age compared to the urban population and usually suffer from chronic diseases. According to a previous national survey, health care stakeholders and leaders place priority on access to efficient, reliable, and quality health care services. It has been reported that the United States has a big surplus of facilities in urban areas such as medical staff and hospital beds. However, these resources are not reallocated to areas where they are needed the most (Andersen, Rice & Kominski, 2007, p. 32).
Access to health care is important in promoting and sustaining the well-being of a population. When people are enabled to gain access to medical care, they have a high chance of getting primary, preventive services. Such services include immunization and education on personal conduct. This also enables early detection and prevention of diseases before they become chronic (Williams, 2011, p. 60). It is unfortunate that access to medical health care today remains elusive to many American citizens. A big proportion of the United States population is not sufficiently catered for by the existing health care system, and many Americans have unmet health care needs. This phenomenon is widely experienced among the vulnerable groups of the American society. There are very many and complex factors that pose problems to access of health care. They range from economic, structural, geographic, social, and cultural factors. The result of inadequate access to health care is that it contributes to poor health of the individual and population at large. Failure to seek treatment can be associated with improper use of emergency services and facilities (Williams, 2011, p. 61).
Various agencies within the department of health and human services (HHS) in conjunction with other federal departments have tried to develop strategies and facilities aimed at improving access to quality health care by the various vulnerable groups of the American population. Programs run by agencies such as the Center for Disease control and Prevention (CDC) and Health Resources and Services Administration (HRSA). Apart from the CDC and HRSA, there are other agencies that have mainly been based on the dynamic dimensions of the health care system. This involves increasing the number of medical professionals, strengthening of the health care infrastructure, offering direct health care to vulnerable groups such as veterans, pregnant women, and provision of community-based services (Committee on Oral Health Access to Services (U.S.), National Research Council (U.S.), & Institute of Medicine (U.S.), 2011, p. 30).
In addition, they also give technical knowledge on health care issues to the local health state departments, carry out national surveys, financing basic and applied research, and carry out public education exercises. Complementary to the federal strategies, other stakeholders are encouraged to increase financing the community health care programs. Such strategies also take steps to address the inequality of access to the health care system by the vulnerable groups in society. In response, the private sector has financed several voluntary, community programs. A good example is the Mission for Mercy program that is behind temporary clinics mainly staffed by volunteering medical professionals. Normally, they are established in areas where the population can get easy access and mainly operate on a first-come, first-served rule (Committee on Oral Health Access to Services (U.S.), National Research Council (U.S.), & Institute of Medicine (U.S.), 2011, p. 31).
According to the institute of medicine, access is a term used to encompass all the concerns that affect the extent to which groups and individuals in society get medical services from the existing medical care system. There are challenges in explaining the meaning of access to health care. However, it has usually been linked to lack of insurance cover and the lack of enough medical professionals and hospital facilities in the affected areas. When an individual has proximity to a health facility, this does not guarantee that this person may have access to medical services. Probably, the best and most effective attempt to define the meaning of access to health care and equity was delivered by the 1983 Presidential Commission. It held that, for equitable access of health care to exist, individuals should be able to acquire reasonable care without a lot of burden. As laid down by the commission, the process of making this moral obligation a reality can be hard (Institute of Medicine (U.S.) & Millman, 1993, p. 32).
This is because deciding on the sufficient level of care can be challenging. What constitutes a sufficient level is relative, and knowing whether these standards have been obtained is difficult. When the IOM committee was evaluating ways of resolving this conflict of ideology, it became apparent that outcomes are as important to the meaning of access as is the utilization of services. After all considerations, the IOM committee defined access as “the timely use of personal health services to achieve the best possible health outcomes” (Institute of Medicine (U.S.) & Millman, 1993, p. 33). It can be noted that this definition depends on both the health outcomes and health care services to provide benchmarks for assessing whether access has been attained. Access is just one of the various aspects that influence health care services and the required outcomes (Institute of Medicine (U.S.) & Millman, 1993, p. 33).
The United States health care system has been trying to give access to health care services to all its citizens for quite some time. In the 20th century, some of the fundamental achievements have been the growth of the private sector, establishment of Medicaid and Medicare programs, the health insurance covers, and the federal efforts in disseminating health care programs. In 2010, Congress oversaw the passage of the Patient Protection and Affordable Care Act (ACA) into law. This is anticipated to lead to a widened insurance cover for all American citizens. It is expected that the ACA will bring down the number of individuals who are not insured. Research has documented impacts and advantages of not being insured. For people with insurance covers, they should have a definite source of health care as compared to individuals without a health insurance cover. It has also been noted that, having many uninsured patients has negative impacts on the health care system. Health care providers tend to shift the extra costs to other patients to subsidize losses incurred from patients without medical covers. Those who came up with the ACA constantly referred to the absence of health care coverage and its implications as the principle reasons for backing the reform legislation (Kovner, Knickman & Jonas, 2011, p. 150).
However, access to health care cannot be viewed from a single perspective. The case of the underinsured reveals that the insurance card on its own cannot cover for other barriers that hinder access to health care services. Other issues should be considered too. Such issues include size and adequacy of the coverage; whether the insurance policy caters for both outpatient and inpatient services; whether it includes costs of prescribe drugs; whether it covers mental health issues, substance abuse and so much more. It is estimated that about sixty million Americans are underinsured. This means that their insurance covers are not sufficient to assure access to health care (Kovner, Knickman & Jonas, 2011, p. 153).
Similarly, the payments made to the health care givers are not sufficient. For example, the low payment rates to medical professionals in Medicaid have hugely had a negative impact on the program. In this case, physicians are not willing to participate in it. This has greatly limited the locations from which Medicaid patients can get medical care. It is also noted that insured patients may also encounter noneconomic barriers that may have a drastic effect on health outcomes, utilization of health services and access. Throughout the United States, the provision of health care remains uncoordinated and enormously fragmented. This makes it very difficult for the patient to get efficient and quality services (Kovner, Knickman & Jonas, 2011, p. 154).
In the United States, race or ethnicity has been intertwined with the social economic status of an individual. Research has further attributed most of the ethnic and racial inequalities in health care provision to socioeconomic statuses. It was noted that the high rate of liver deficiency was due to hereditary causes among the Asian immigrants (Gaston, Ayres, Dooley & Diethelm, 1993, p. 75). Researchers argue that the status of minority groups is a fundamental factor in how health care services are used, as well as the impact on the outcome of health care usage. In researches where adjustments were made for differences in insurance coverage, African Americans suffering from the end stage renal disease had a 50% less chance of getting a kidney transplant when compared to the white Americans who received transplants. However, when they finally got a kidney transplant, it was noted that they had waited for a considerably long period (Gaston, Ayres, Dooley & Diethelm, 1993, p. 76).
In general, the bearing of culture and acculturation on health care systems is not clearly known. It is assumed that cultural barriers might lead to limited utilization of health care especially among the Hispanic and Asian immigrant groups (King, 1999, p. 32). These barriers may involve a wide range of probable problems including, lack of trust of modern western medicine, isolation of the society, different perceptions about the disease and illness, general fears of their immigration status especially if they are not registered, and availability of alternative health care services. Researches have been carried out to investigate the extent to which acculturation tends to resolve these barriers. This research has been limited by the inefficiency of defining and accrediting the levels of acculturation. Some of the researchers argue that proficiency in language may be the best evidence of acculturation in facilitating health care access (King, 1999, p. 36).
Access to health care is influenced by very many factors some coherent and other incoherent. Although the United States government has achieved considerable progress in ensuring equitable access to health care services, there is a lot that needs to be done. Notably, the private sector owns a considerable number of health care facilities. The federal government should allocate significant resources in the health sector to facilitate the achievement of meaningful gains. The government should come up with laws that will encourage private sector involvement in community-based projects. This can be in the form of tax cuts for organizations that offer free medical clinics.
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Committee on Oral Health Access to Services (U.S.), National Research Council (U.S.), & Institute of Medicine (U.S.). (2011). Improving access to oral health care for vulnerable and underserved populations. Washington, D.C: National Academies Press.
Gaston, R.S., Ayres, I., Dooley, L. G., & Diethelm, A. G. (1993). Racial Equity in Renal Transplantation. The Disparate Impact of Hla-Based Allocation. Journal of The American Medical Association, 270(11): 1352-6.
Institute of Medicine (U.S.), & Millman, M. L. (1993). Access to health care in America. Washington, D.C: National Academy Press.
King, J. (1999). Access to health care for American Indians and Alaska Natives: A comparative approach. Madison: University of Wisconsin.
Kovner, A. R., Knickman, J., & Jonas, S. (2011). Jonas & Kovner’s health care delivery in the United States. New York, NY: Springer.
Shi, L., & Singh, D. A. (2012). Delivering health care in America: A systems approach. Sudbury, Mass: Jones & Bartlett Learning.
Williams, R.A. (2011). Health care disparities at the crossroads with health care reform. New York: Springer.