Assessment 4: Analyzing a Current Health Care Problem or Issue

Assessment 4: Analyzing a Current Health Care Problem or Issue

Limited access to healthcare is an issue of focus in this paper. Healthcare providers and other stakeholders in health actively focus on implementing policies that aim at eliminating the barriers to access to healthcare. All individuals have the right to access the care that they need for their optimum health and functioning. However, factors such as the high cost of healthcare, lack of medical insurance coverage, shortage of specialists, and geographical disadvantages have continued to worsen the challenges that most experience in accessing the healthcare they need. Therefore, this research paper analyzes the issue of limited access to healthcare, its causes, potential alternatives, and a solution that should be adopted to address it.

Elements of the Problem or Issue

Despite being a developed country, some of the populations in America still experience limited access to healthcare. For example, the existing statistics show that patients suffering chronic illnesses such as mental illnesses experience considerable challenges in accessing the care that they need due to factors such as stigmatization, ignorance, and prejudice. Geography is another factor that plays a crucial role in limiting healthcare access. According to Matin et al., (2021), residing in rural settings act as a barrier to access to the needed healthcare for the population. The participants in the study by Martin et al., (2021) reported that they incur significant transportation cost in accessing the healthcare facilities based on their geographical locations. In the study by Malik-Soni et al., (2022), factors that include physician shortage, stigma, high cost and shortage of services, limited insurance, and communication difficulties with physicians limited access to care for patients with autism spectrum disorder. Unforeseen events such as the recent changes due to covid19 pandemic also limit healthcare access for the population. For example, Jeste et al., (2020) found in their research that covid19 restrictions led to a loss of at least some healthcare services for patients with intellectual and developmental disorder. The effect was seen from 74% of the patients losing access to at least one therapy or educational service. Policy changes made in the country also act as a source of barriers to access to healthcare in America. For instance, most of the policy initiatives adopted policies in healthcare continue to limit the access of immigrants in the USA to healthcare (Buchmueller & Levy, 2020). A small proportion of noncitizen immigrants in the state have Medicaid, which worsens healthcare access for most of them.

Healthcare cost in the United States of America is also among the highest of all the developed nations globally. Accordingly, the USA spends the highest amount of per capita on person’s healthcare as compared to other countries such as Canada and the United Kingdom. The high cost of healthcare is a disadvantage to the majority who are in low socioeconomic group. Compounded by factors such as the lack of medical insurance coverage and residing in rural areas, the population experience considerable challenges in accessing the high quality care that they need (Lee & Porell, 2020).

America is also a multiethnic country. Factors such as race and ethnic backgrounds influence access to healthcare services. Often, individuals from ethnic minority backgrounds experience disproportionate barriers in accessing the healthcare that they need. The recently experienced challenges during Covid19 revealed that the pandemic disproportionately affected some ethnic and racial minority groups. The impact was attributed to the high uninsurance rate among African Americans (12%) and Hispanics (19%) as compared to whites (8%) (Tai et al., 2021). According to Thakur et al., (2020), structural and social circumstances place racial and ethnic minority groups at risk of diseases and worse outcomes due to limited access to healthcare. For example, African Americans and Latino Americans, which form part of the ethnic minority groups experience barriers such as lack of insurance, unemployment, and low income, which limit access to quality healthcare they desire for their health and wellbeing (Petersen et al., 2019).

Analysis

Nurses must be aware of the factors that contribute to limited access to healthcare for the American population. The awareness stimulates them and other healthcare providers to advocate the adoption of policies that increase the universal access to healthcare for all. Nurses also explore the incorporation of novel technologies such as telemedicine, telehealth, and mhealth into the adopted solutions to address limited access to healthcare for the population (Jeste et al., 2020). Studies have demonstrated that technologies such as telemedicine and telehealth increase the access to healthcare for the vulnerable populations and those residing in rural areas since they can interact with their practitioners virtually (Haynes et al., 2021). The consideration of these options will likely to increase healthcare access for all.

Context of Limited Access to Healthcare

Limited access to healthcare refers to the disproportionate utilization of healthcare services by the population because of factors that may be beyond their control. The vulnerable populations that include people with disabilities such as those intellectual and development disabilities, autism spectrum disorders, and women with disabilities (Huot et al., 2019; Jeste et al., 2020; Malik-Soni et al., 2022). Racial and ethnic minority groups also suffer from limited access to healthcare because of social and structural factors such as lack of health insurance, unemployment, and low income (Thakur et al., 2020). In addition, the socioeconomically disadvantages, individuals with chronic health conditions, women, children, and the elderly experience disproportionate limited access to specialty care, especially in the medically underserved rural and urban areas (Cyr et al., 2019).

Limited access to healthcare is attributed to multilevel factors. At the foundational level, geography plays a crucial role in limiting access to healthcare. Accordingly, patients residing in rural areas experience unique challenges such as the lack of physician care and high transportation costs in seeking the care they need in urban areas. According to Cyr et al., (2019), one-fifth of the USA’s population resides in rural areas and being served by one-tenth of the clinicians practicing in these areas. In addition, most of the rural dwellers are likely to be older, veterans, uninsured, or less likely to have higher education, which limits their access to healthcare (Cyr et al., 2019).

At the individual level, factors such as poverty, low income, unemployment, lack of medical insurance coverage, ignorance, and negative experiences with healthcare services influence access to and utilization of healthcare services. At the healthcare system level, variance in healthcare costs, negative patient experiences with healthcare services and providers, staff shortage, and fragmentation of healthcare services hinder the population’s access to the healthcare they need. At the policy level, constant changes in healthcare policies such as the enhancements of the Affordable Care Act lowers the types of healthcare services that the population can access (Buchmueller & Levy, 2020). Consequently, these factors contribute to the worsening challenges in access to healthcare for the vulnerable in the country.

Populations Affected by Limited Access to Healthcare

The unemployed, poor, and individuals from ethnic minority groups are most vulnerable to limited access to healthcare. Individuals from ethnic minority backgrounds often have increased predisposition to health problems such as diabetes, hypertension, and depression among other issues. They also experience significant challenges in accessing healthcare they need because of lack of medical insurance coverage, unemployment, and low wages (Petersen et al., 2019). The other group of people likely to experience limited access to healthcare include the elderly rural dwellers, with low income, educational levels, and veterans, who have challenges in accessing specialized care they need. Children, those with disability, women, and elderly in medically deprived urban and rural areas are also highly likely to experience limited access to healthcare (Cyr et al., 2019).

Considering the Options

One of the solutions that can be considered to address the issue of limited access to healthcare due to geographical residence is adopting new policies that support care delivery models that rely on team-based care and nonphysician providers (Germack et al., 2019). A study conducted by Germack et al., (2019) showed that most of the rural hospitals in the USA are unable to address the needs of their populations because of physician shortages. As a result, they are at the verge of closure should the problem persist. However, an effective solution proposed by the researchers is the adoption of non-physician providers and team-based care to address the issue. This includes the hiring of more nurse practitioners to fill the physician shortage, hence, assuring the rural residents access to high quality care they desire. Besides, delivery models such as rural clinics and medical homes that rely on team-based care could augment the physician workforce, hence, increased access to the medically underserved rural and urban dwellers (Germack et al., 2019). The challenge associated with this solution is that it may take time for its implementation since it requires a change in the existing healthcare policies.

Limited access to healthcare can be addressed by embracing technologies such as telehealth and telemedicine to expand healthcare coverage for the vulnerable. Telehealth and telemedicine allow healthcare providers and their patients to interact irrespective of their geographical locations. Healthcare providers can assess, monitor, and evaluate the effectiveness of the adopted interventions for optimum care outcomes. Issues associated with health technologies that may affect their adoption include data breaches leading to the loss of confidentiality and privacy (Haynes et al., 2021). The challenge of not addressing the issue of limited access to healthcare is that it would worsen disproportionate rates of poor health outcomes among the vulnerable populations.

Solution

Limited access to healthcare, especially due to residing in medically underserved regions is a crucial public health problem. However, the consideration of team-based model of care and use of non-physician healthcare providers is a sound solution to the problem. For example, nurse practitioners have been trained to deliver care like that of the physicians. Policy changes that recognize the need for hiring more nurse practitioners would help address the physician shortage, hence, increasing the population’s access to specialized care in undeserved regions. In addition,  delivery models such as rural clinics and medical homes that rely on team-based care could augment the physician workforce, hence, increased access to the medically underserved rural and urban dwellers (Germack et al., 2019).

Implementation

The consideration of policy reforms that incorporate team-based model of care and use of nonphysician providers is an effective solution to the problem of limited access to healthcare. Its implementation requires interventions such as lobbying for policy change, hiring more of nonphysician staff, and redesigning the existing model of care delivery to increase team-based approaches in the care process. The ethical principles that should be considered include justice. The adopted policy should ensure that all the populations have universal access to high quality, safe, and efficient care. The population should also not be discriminated in accessing the care they need based on their backgrounds. The principle of beneficence and non-maleficence should also be considered by ensuring that the target population is not predisposed to any unintended harm from the proposed policy reforms (Haynes et al., 2021). The use of non-physician providers should not lower the quality, safety, and efficiency of care that patients receive. It should also not subject them to any unintended harm in the disease management process.

Conclusion

Limited access to healthcare is an issue that should be addressed in America. Factors such as cost of healthcare, residing in rural settings, and lack of medical insurance coverage contribute to the issue. An effective solution to address it would be policy reforms to increase the use of non-physician providers and team-based approach to care. Nurses should consider ethical principles in implementing the solution.

References

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Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019). Access to specialty healthcare in urban versus rural US populations: A systematic literature review. BMC Health Services Research, 19(1), 974. https://doi.org/10.1186/s12913-019-4815-5

Germack, H. D., Kandrack, R., & Martsolf, G. R. (2019). When Rural Hospitals Close, The Physician Workforce Goes. Health Affairs, 38(12), 2086–2094. https://doi.org/10.1377/hlthaff.2019.00916

Haynes, N., Ezekwesili, A., Nunes, K., Gumbs, E., Haynes, M., & Swain, J. (2021). “Can you see my screen?” Addressing Racial and Ethnic Disparities in Telehealth. Current Cardiovascular Risk Reports, 15(12), 23. https://doi.org/10.1007/s12170-021-00685-5

Huot, S., Ho, H., Ko, A., Lam, S., Tactay, P., MacLachlan, J., & Raanaas, R. K. (2019). Identifying barriers to healthcare delivery and access in the Circumpolar North: Important insights for health professionals. International Journal of Circumpolar Health. https://www.tandfonline.com/doi/abs/10.1080/22423982.2019.1571385

Jeste, S., Hyde, C., Distefano, C., Halladay, A., Ray, S., Porath, M., Wilson, R. B., & Thurm, A. (2020). Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID-19 restrictions. Journal of Intellectual Disability Research, 64(11), 825–833. https://doi.org/10.1111/jir.12776

Lee, H., & Porell, F. W. (2020). The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status. Medical Care Research and Review, 77(5), 461–473. https://doi.org/10.1177/1077558718808709

Malik-Soni, N., Shaker, A., Luck, H., Mullin, A. E., Wiley, R. E., Lewis, M. E. S., Fuentes, J., & Frazier, T. W. (2022). Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatric Research, 91(5), Article 5. https://doi.org/10.1038/s41390-021-01465-y

Matin, B. K., Williamson, H. J., Karyani, A. K., Rezaei, S., Soofi, M., & Soltani, S. (2021). Barriers in access to healthcare for women with disabilities: A systematic review in qualitative studies. BMC Women’s Health, 21(1), Article 1. https://doi.org/10.1186/s12905-021-01189-5

Petersen, R., Pan, L., & Blanck, H. M. (2019). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action. Preventing Chronic Disease, 16, E46. https://doi.org/10.5888/pcd16.180579

Tai, D. B. G., Shah, A., Doubeni, C. A., Sia, I. G., & Wieland, M. L. (2021). The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States. Clinical Infectious Diseases, 72(4), 703–706. https://doi.org/10.1093/cid/ciaa815

Thakur, N., Lovinsky-Desir, S., Bime, C., Wisnivesky, J. P., & Celedón, J. C. (2020). The Structural and Social Determinants of the Racial/Ethnic Disparities in the U.S. COVID-19 Pandemic. What’s Our Role? American Journal of Respiratory and Critical Care Medicine, 202(7), 943–949. https://doi.org/10.1164/rccm.202005-1523PP