Access to health care refers to the individual’s ability to obtain and use needed services (Ellis & Hartley, 2008). Access to health care affects a multitude of people. Uninsured, underinsured, elderly, lower socioeconomic class, minorities, and people that live in remote areas are at the highest risk for lack of access to health care. There are also economical and political roles that complicate access to health care. Access to health care is a multi-faceted concept involving geographic, economics, or sociocultural issues.
With my extensive research on access to health care, I hope to provide influences regarding; who is affected by lack of access, geographic, economic, sociocultural access, and political, legal and ethical implications. Economical and political access to health care is in huge debate currently, from health care reform, Medicare, and Medicaid. Economical and political access affects most of the population. Economic access is often dependent on having a health plan or being eligible for one of the government programs (Ellis & Hartley, 2008). The U.
S Census Bureau estimates that nearly 50. 7 million Americans do not currently have health insurance (p. 24). Ever since its inception, access to health care has been a heavily debated topic both on a federal and state level. The argument has been made for the implementation of health care reform due to the increasing number of uninsured and underinsured American citizens. The World Health Organization (2006) assessed that, “the highest standard of health should be within reach to all, without distinction of race, religion, political belief, and economic or social condition” (para. ). Ellis and Hartley (2008) point out, private insurance companies raise deductibles and co-payments in attempt to get patients to use services wisely. This sounds great in theory; however, lower income families may delay or avoid timely care. Uninsured and underinsured citizens are finding it extremely difficult to pay for insurance premiums and deductibles. This limits the care they can receive, and at which institutions they have access.
American citizens with prior underlying health conditions or other issues are forced to pay expensive health care premiums, thus, preventing individuals from lower socio-economic statuses to afford health insurance. In 2007, 62. 1% of all bankruptcies were medical; 92% of these medical debtors had medical debts over $5000 (American Journal of Medicine, 2009). Political influence plays a huge role in access to health care; with health care reform, Americans can have access to gain the coverage needed for proper health care. However, agreeing upon what health care reform will consist of has been of particular argument among political leaders.
Democrats and Republicans have long since failed to agree upon a mutual consensus regarding the future health care reform. This long-standing difference in ideology between these opposing factions has made passing new health care legislation difficult. Another solution to access to health care that has been proposed is, standardizing health care. Standardizing national health insurance will not be an easy process. Numerous private-sector insurance companies have a financially-vested interest with their consumers. Nationalizing health care would place the federal government as a direct competitor against these companies.
U. S. citizens would have the decision on purchasing private insurance or insurance offered by the government, which could ultimately affect private corporations’ outcome. Another group with interest in reform and affected by limited access to health care is, aging American citizens. The elderly will see a drastic change in their Medicare benefits due to the government cutting nearly $500 billion from the Medicare program (Himmelstein, Thorne, and Warren, 2009). This change in benefits could cost senior citizens substantially more for the same services provided prior to the health care reform.
Health care reform is greatly needed to aid the financially-draining Medicare system. The growing concern regarding the financial security of Medicare is one of particular interest to the nearly 72 million baby boomers that become eligible for this government-assisted, and tax-payer bolstered, program over the next two decades. According to the U. S. Census Bureau (2010), there will be a rapid increase in baby-boomers between 2010 and 2030, as the entire baby boomer population move into the 65 years and over category (p. 3).
Political and financial revisions must be made to ensure the security of Medicare as the numbers of individuals paying into this program are soon to be surpassed by the number of individuals drawing-off this program (U. S. Census Bureau, 2010). The elderly are also at a disadvantage with transportation to health care visits, picking up prescriptions, and rehabilitation services. There needs to be an establishment of access not only to primary care providers, hospitals, and rehabilitation services, but access to other aspects of the health care system for the elderly population.
Sociocultural differences, according to Ellis and Hartley (2008), also affect access. If a patient feels uncomfortable in a health care setting related to their socioeconomic status or they feel their beliefs are not respected, they are hesitant to use services provided (Ellis & Hartley, 2008). Awareness and sensitivity to different lifestyles and beliefs can lessen misconceptions and minimize barriers that interfere with optimal provision of patient-centered care and services. By working through established community norms, building trust, and effectively applying cultural competency techniques; access will be within better reach.
The Amish community is quite large in southwest Missouri; the Amish believe in natural healing, and the Amish community has a say if treatment will or will not be given. This is an example of respecting their “cultural” norm. According to, Sharpnack, Griffin, Benders, Fitzpatrick (2010), “Spiritual and alternative healthcare practices exist in all traditions and cultures, challenging the assumptions and care models used by healthcare providers for cultures outside the mainstream” (para. 1). Information about the diversity and prevalence of practices in different cultures need to be addressed to care for the patient as a “whole. Language barrier among patients and health care providers also place limits on access to health care. It is vital for health care providers to respect cultural differences and attempt to provide translation services, and provide written material in more than one language. Geographical access to health care is also a concern regarding access to health care. Rural area hospitals are finding it harder to compete and manage financially; this is leading to some closures of hospitals (Ellis & Hartley, 2008).
Access to health care in a rural community is also limited by lack of practicing physicians and services being available in one area (Ellis & Hartley, 2008). Access to health care in urban areas has cause for concern as well; economically depressed areas of large cities have fewer health care providers (Ellis & Hartley, 2008). According to Hansen-Turton, Bailey, Torres, and Ritter (2010), “The shortage of primary care physicians who care for adults (in internal medicine and family medicine) is projected to reach 35,000 to 44,000 by 2025. ” (p. 23) There have been great advances in the technological aspect of medicine.
Access to health care by way of electronic medical records (EMRs) has opened the door for continuity of care. The EMR contributes to a common platform between different components such as; lab, radiology, ordering and results, electronic prescribing, hospital results and other documentation. This in turn has made it easier to correlate a patient’s data and present it at the point of care. When combined with the ability to normalize data from multiple sources and easily access it over the Web, it enables providers to benefit from a complete patient-centered record that creates a unified, continuously updated view of each patient care episode.
According to, Uzma, Mitchell, Day, and Hardin (2008), Electronic clinical records contain information on all aspects of healthcare. Healthcare information systems collect large amounts of textual and numeric information about patients, visits, prescriptions, physician notes etc. The electronic documents encapsulate information that could lead to improvement in healthcare quality, promotion of clinical and research initiatives, reduction in medical errors and reduction in healthcare costs. (p. 52). With the advancement of the EMR, some hospitals are allowing patients to have access to their own medical records.
According to Frampton, Horowitz, and Stumpo (2009), “Open medical record simply denotes a formalized way of allowing patients to access their medical records. It’s part of a philosophy of care based on the idea that patients should have the choice to be involved in their care” (p. 59). An additional advancement in technology in health care access is telehealth. Technology has now allowed nurse and physicians to “see” patients in their home by way of television. “A National Library of Medicine review reported that 50,000 households were using telecare services in 2006, and the number was increasing rapidly.
Most U. S. telemonitoring programs are for homebound older adults, veterans, or rural residents” (Smith, 2008). With the ongoing advancement of technology, access to health care will hopefully become more in reach for those underserved. Legal and ethical concerns in regards to access to health care may include; limitation of patient’s access to medical care by pre-treatment (related to managed care not allowing it), inappropriate provision of care, premature patient transfer and discharge related to inability to pay, and refusal of an insurance company to provide treatment authorization as medically necessary.
Ethical concerns include; breaches of confidentiality, lack of protection of the medical record, and misuse of medical information to deny future insurance. Changes are needed in all aspects of nursing; education, research, and practice. With the passing of health care reform, increased funding and grants will become available to aid in advancing nurse education and loan forgiveness. Nurse education curricula needs to take on a “community” focus for disease prevention and treatment. An emphasis in the areas of cultural competency and training to meet the needs of an increasingly diverse and aging population is also needed.
It is essential to understand the evolving nature of the health care field, ongoing research is important for the professional nurse. The recent passage of the Affordable Health Care for America Act will have a profound impact on millions of U. S. citizen seeking medical care in the upcoming future. Therefore, it is imperative that nurses remain up-to-date and educated on the dynamic and precedent-setting nature that this legislation will have on the health care system. Nurses can be affected in other ways due to health care reform and limited access to care.
Hospital-based nurses can expect to see an increase in the number of patients wishing to receive care. As coverage is extended to more American citizens, a higher influx in the number of patients could spell a higher demand in the amount of nurses it requires to staff hospitals and clinics. As members of the nursing profession, nurses will be asked questions, opinions, and advice regarding access to health care and health care reform, as providers we should be able to provide informed answers. Many U. S. citizens chose medical therapies based solely on the guidance they receive from health care providers.
It is essential for nurses to build a solid understanding of access to health care. By doing so, we will facilitate patients to take full advantage of every provision that enhances care for themselves and their families. Nursing philosophy is based on helping patients stay at their optimal level of health. This is why I chose access to health care. In primary care settings like the hospital emergency room, nurses are often the patient’s point of entry to the healthcare system. The nurse is the first person they see and the one who assesses and determines where they are on the health-sickness continuum.
When you talk about setting up resources for patients either in the hospital or out in the community, it’s the nurse who organizes them. The impact on access to health care for nursing not only for my job, but all aspects of nursing is prevention and wellness. Nurses excel and help support access to health care in communities — school based clinics, nurse-managed clinics, home care, transitional care, and rural area healthcare, this is important aspect of nursing to me. There are opportunities to save money and improve health through prevention.
According to Mokdad, Marks, Stroup, and Gerberding (2004), preventable causes of death, such as tobacco smoking, poor diet and physical inactivity, and misuse of alcohol have been estimated to be responsible for 900,000 deaths annually, nearly 40% of total yearly mortality in the United States. With competent patient education from nurses maybe we can decrease unnecessary hospital visits. No single approach will adequately address the multi-faceted problem of improving the access and health care status of Americans. It is apparent that the health care system is undergoing vast transformation designed to make it more just.
Disparities persist in access to care between uninsured and those with coverage, be it private, Medicaid, or Medicare. Patients without insurance consistently report lower use of preventive services, more difficulty paying for care and medicines, and greater barriers to obtaining services. While employer-sponsored insurance was once considered the “gold standard” of coverage, there is evidence of cracks and great strain on the private system. If health care reform is to include better health care for Americans it will need to do more than assure economic access through expanding insurance.
It will need increased availability of providers, expand the use of EMRs, focus of disease prevention, community health, and increase funding to nurse education. Access to health care is a key player for patient’s economic and health security and family well-being. As policymakers, providers, patients, advocates, and researchers develop strategies to strengthen the health care system, it is crucial they recognize patient’s central role in the system and how much is at stake for them as a consequence of their decisions.