The American society has evolved over time. From being comprised of small settlements, it turned into one big, complex structure populating an entire continent. New races and cultures came to the country and assimilated with the prevailing white culture. New technologies and breakthroughs were discovered. As the society matures, its standard of living also improves. As the society develops and becomes more advanced and wealthy, its people also acquired new needs. One of which is the recognition of the importance of keeping the people healthy by providing them with access to medical services. The health care system was then established to answer the medical needs of the American people. For a time, the health care system was benefiting people from all walks of life since costs were still manageable.
Despite the improvements in the standard of living and living conditions, the country was far from perfect. A perfect society is practically non-existent, particularly among the developed and civilized ones. While smaller, primitive groups have very basic needs and follow a strict social structure, this could not be the case for larger ones like the United States. Being democratic in nature, the country follows the rule of equitable and fair sharing. This means that every decision and action taken by the government is directed for the good of the majority of the people. Majority means that there are always some sectors who do not reap the benefits of a particular decision, which may cause dissatisfaction in some cases. Ideally, the country should have a happy and contented people since it is considered to be one of the wealthiest and most advanced in terms of knowledge and culture. But since the government cannot monitor every aspect of living, there are opportunities for social problems to develop and persist.
As an imperfect society, America is susceptible to social ills. Among the myriad of social problems that plague the country, the issue on health care came to the forefront in recent years. It is one of the most important social problems as it affects a lot of the people. Health care problems are divided into three: cost, access and quality. Health care costs have risen considerably high for the past few years causing the government to allocate more and more of its budget in order to continue providing the people with the medical services they need. Access has also become a controversial issue since not everyone gets the same kind of medical services. Finally, quality of health care has also surfaced because of the dissatisfaction of patients concerning the medical services that they are supposed to get. Since health care is a broad spectrum, this paper will limit its focus on the issue of access. According to many published papers, there is an inequality of access between the rich and the poor, and the white and non-white people in society. This paper recognizes that there is, indeed, disparity in health care access due to ethnicity and economic factors. Since ethnicity is a broad topic on itself, this study will exclude it as a factor. Aside from financial capacity, this paper will also look into other factors that hinder a person from accessing the health care services he needs. These factors are:
l physical limitations due to disability or age,
l structural limitations,
l personal barriers like lack of adequate knowledge on the health care services available under a particular program,
l citizenship status, and
l perception of illness.
Using previously published studies to identify the factors that affect Americans' access to health care, this paper will also provide some suggestions on how the negative factors can be mitigated in order to improve access among various social groups.
Literature review
The US has a healthcare that is funded by many independent legal bodies. A lot of resources are directed towards healthcare. The US government has developed an employer friendly system where they exempt taxation on the money that is submitted for healthcare insurance. This tax waiver totals close to 150 billion every year. It was observed that the US spent much more per capita healthcare than other countries. It was placed second to Marshall Islands in allocating the largest proportion of its GDP towards provision of healthcare to its citizens. In a study conducted by the World health organization in 2000 that included 191 member nations, the U.S. health care system was rated as the most responsive and also had the highest expenditure both overall and per capita healthcare, but it was 37th in performance in terms of efficiency and service delivery. The US healthcare system was ranked 72nd by overall level of health. The US healthcare was ranked 41st in the world for lowest rates of infant mortality.This study estimated that due to an increase in the need of better healthcare to increasing population of its citizens, this portion of GDP allocated to healthcare would continue rising. In 2007 this was at 15.2%. The national health expenditures project an exponential increase of the government expenditure to healthcare for the next 10 years from 16.5% of GDP in 2006 to 19.5% in 2017 if the current system is maintained (qtd in Appleby 12).
The country’s budget office accounted that this rise in prices of healthcare will result from an increase in the complexities of medical procedures and technology growth, global inflation, higher income levels and varying insurance policies (Bandow 44).In 1996 the Medical Expenditure Panel Survey found that healthcare spending in the US is mainly concentrated in 5% of the population using more than half of the resources allocated while 1% of the population with the highest spending accounted for 27% of aggregate health care spending (Appleby 25).
A study of the healthcare system by the agency for healthcare research and quality (AHRQ) depicted relevant persistence in the allocation of health care spending from each year to the next. In the spread among different age groups it was observed that seniors tended to use more than half of the resources that were used by the rest of the population. From 1987 to 2004 data suggests that the healthcare costs of the old retired citizens remained relatively constant when compared to the rest of the population (Bandow 66).
In a 2007 survey the Kaiser Medical foundation observed that an average worker in the US paid 16% for single coverage insurance premiums while those with families paid 28% for insurance cover. These insured people were also required by the policies to pay for additional services where some medical procedures had been locked out by the premium and in the form of co payments.The census bureau discovered that in the population that did not have adequate insurance, 64 million individuals were employed. Among the non insured a fifth could possibly afford healthcare. This study also established that the larger population of uninsured people comprised of legal citizens of the United States while about 10 million were non citizens. 56% of the total uninsured US population needed financial assistance to meet healthcare needs (Bandow 312).
The government already uses a lot of money to take care of the medical needs of the uninsured. It is estimated that the United States government uses $65–$130 billion on uncompensated medical care of uninsured individuals every year. Federal government spends most when it comes to paying for uninsured healthcare and uncompensated healthcare through offering tax appropriations direct payments and grants. The state and local tax appropriations for healthcare facilities provide for the remainder.
Methodology
The analysis was based on different case studies where the nationalized healthcare system is implemented and was used to evaluate the health crisis is US and reach a conclusion. Much of the information that was used was obtained from various health journals and the US census bureau. The world health served as a wide resource in evaluating the two systems of health as well as the Kaiser Foundation publications. The United Kingdom which has implemented a nationalized system serves as a better comparison since it also houses several countries. The books by Anderson, Bandow and Appleby provided the useful data and guidelines to conduct this study.
DISCUSSION
Financial/Economic
The federal government shoulders a large portion of the costs associated with health care services while the rest is borne by the individual citizens. In recent years, it has become increasingly costly for Americans to obtain health insurances as prices soared. Those who cannot afford to insure themselves avail of the Medicaid or some other form of social health programs. Ahmed, Lemkau and Nealeigh (2001) relate that because of financial difficulties, many people are hindered from getting access into quality health care services. In a study of Dayton's urban poor, Ahmed et al. find that mortality and medical morbidity are higher among low-income households compared to the more affluent ones. The recent economic meltdown has caused thousands of people to lose their jobs, which means more people with lesser insurance coverage or no coverage at all.
Although policymakers and the federal government have explored areas in which access to health care can be improved, it is apparent that any changes will not take place in the next couple of years. The government is faced with mounting problems on how to restructure the economy and it cannot afford to give health care programs a higher budget allocation. In this regard, it is even possible for the poorer families to meet more barriers to health care access. Also, those who find themselves suddenly out of work will also put less priority on health care insurance to meet more pressing needs like housing, food and education.
Physical Limitations
Physical limitations like age and disability also affect health care access. The older population and those with disabilities are often the ones who most need preventive care but underutilized those services. Geriatrics and disabled people often find themselves in the emergency rooms because of worsening conditions (Drainoni, E. et al., 2006, p. 1). These people are generally insured, yet, because of their physical limitations they would rather self-medicate or wait before availing for themselves the necessary treatments. In other cases, the older population and the disabled persons may opt to delay, avoid, or forego medical attention because of their inability to find people who can help them navigate the health care system. There are also those who cannot leave their houses because of the loss of their faculties or who are mentally retarded. These people depend on other adults to take care of their health needs.
Structural Barriers
Structural barriers to health care access include the absence of telephones and transportation means. Those without telephone lines find it a barrier to access because some health care-related information are relayed through the telephone. Without this communication means, many households fail to receive information on free or discounted health services. They could not also call providers to seek for information and schedule for appointments. Difficulty with health care access also arises for people who do not own at least one vehicle or who could not find transportation during instances when health services are needed (Ahmed & Lemkau & Nealeigh, 2001, p. 447). In emergency situations, the absence of transportation could further endanger the life of a patient. Transportation problem is more common among very poor households.
Personal Barriers
The personal barriers that affect health care access include: lack of adequate knowledge, difficulties arising from work and finding someone to look after the children, and negative experiences with health care services in the past. Morgan (2008) describes in a study how patients enrolled under the Medicare have poor access to medical care because of a lack of proper understanding of the benefits and services that are included in their plans. Because of the absence of adequate knowledge, perceived health care services that can be accessed are relatively lower than what the program provides for. In other families, health care access is also affected when no one is there to tend the children while the mother or father will visit a provider. Without a trusted person to watch the kids, medical care is often delayed or avoided. For those people who are working, they sometimes find it difficult to leave work especially when they won't get paid for the hours they are absent from work. Finally, negative experiences in past related to health care providers can traumatized patients and prevent them from seeking medical care.
Citizenship Status
Yu et al. (2008) found in a study that one of the factors affecting health care access is on citizenship status. While previous studies have discussed ethnicity, the focus was not on status. It is important to note that there are many people in the country who are not legal immigrants. These people are obviously uninsured. Their status as non-citizens prohibit them from obtaining health coverage, thus, limiting their chances of accessing the right medical care. Even among the legal immigrants, Yu's study revealed that many lack health care access particularly those who live in Texas, Illinois and California, especially for those who were not born in the United States. Citizenship status results to a more complex categories for immigrants, which translates to confusion on what services are they eligible to have. Yu's findings affirmed Jang et al.'s (1998) study of citizenship as a barrier for health care access. Jang previously found that non-U.S. born immigrants have lower chances of getting adequate health care services. These findings reflect the prioritizing of recipients in such a manner that the system becomes unfair to many immigrants who are also making positive contributions to the society and paying taxes. The health care system in this regard becomes a barrier on itself.
Perception of Illness
Access to health could also be affected by a person's perception of his health (Copeland, 2005). Perception plays a vital role on health care access. While some people are eager to seek medical advice from their providers, some will only do so when their conditions have already worsened. A person who does not believe he needs medical attention will not seek the services of health care providers. Or a person may suffer from an illness but refuses to seek medical attention because he does not see its necessity. Perception becomes a barrier to access not only to the individual but for others as well. For instance, when a mother does not believe her child's illness is a cause for concern she will not seek medical help. She will probably try medications known to her to avoid going to a provider. In this instance, the mother's perception of her child's illness becomes a barrier to the child's access to health care. The child may be insured but he cannot visit a provider on his own since he is dependent on his parent to make decisions concerning his health. This could also be true for an aged parent who suffers from an illness but his child may think it is not necessary for the parent to see a health care provider.
Recommendations
Financial/Economic
l The government must negotiate deals with health maintenance organizations and health care providers and institutions in order to lessen the costs of insurance and medical services. Since the economic reality of the country is not good, health care costs should lower to make health insurances more affordable to the lower income people.
l For those without work or who belong to the poorest of the society, the government should at least provide them with basic and emergency access to health care. Some hospitals and medical institutions should be for the exclusive use of those who are very poor.
Structural barriers
l Health centers must be established in areas identified as poor where access to basic medical services is available 24 hours a day. The facility should also provide telephone lines for use on emergency basis and transportation of patients who require medical attention. In the health center, people can also obtain preventative medical care.
Citizenship status
l Health policymakers should take a closer look at legislations governing access to health care based on citizenship status. The foundation of medicine is the saving of lives and as such, no one should be denied access to health care. Current laws must be amended to fairly and equitably provide for all residents of the country.
Personal barriers
l Knowledge concerning health care services, benefits and programs can be improved through an information campaign. The government must send leaflets to every household in order for everyone to understand the health care system. As for child care and work hours, these are barriers that an individual must solve on a personal level.
Physical limitations
l Health centers can routinely visit households in their districts to check on those people who cannot seek medical attention on their own due to a disability or old age. In this manner, they will know who needs constant monitoring.
Perception of illness
l Perception of illness is another barrier that must be solved on a personal level. An information campaign concerning illnesses can only do so much. It is still up to the individual whether to believe the information or not.
Conclusion
Access to the health care system is a major social problem facing the country today. The effects of however a proper health care system would be as follows:
- Everyone would be able to get proper treatment without any price.
- People will be much careful about their health and will soon start preaching health issues in the environment.
- Through an act to improve the health care system, we can diversify knowledge into various parts of the country where people are still unaware of the fact of livelihood.
- People would have much knowledge about the population crisis and then coming to the point they will avoid things injurious to health and will consult doctors as per their prescription.
Because of how expensive it is to be insured, it becomes a matter of the well-off individuals having more access to health care services. While the financial aspect is the biggest factor in access, there are other barriers as well that are not directly related to wealth or economic capacity.
© PrimeWritings 2006
