What is Health Care Environment Policy and Lack of Insurance and Service Providers In United State. Currently the US, compared to similar Western countries, has the lowest life expectancy at birth, highest reported maternal and infant mortality, highest hospitalization rate from preventable causes, highest death rate for avoidable and treatable conditions, highest suicide rate, and highest chronic disease burden rate
The Health Care Environment Policy and Lack of Insurance and Service Providers In United State
In the United States, healthcare access and affordability are significantly compromised by the lack of universal health coverage and a widespread, complex, and often underfunded insurance system. This results in large numbers of uninsured and underinsured individuals, creating inequalities in access to healthcare and necessary services. Furthermore, even with insurance, many people struggle to find providers who accept their individual plan due to low reimbursement rates, especially those with Medicaid or Medicare.
Insurance Coverage
High Uninsured Rate:
Despite the Affordable Care Act (ACA) and other initiatives, a substantial portion of the US population remains uninsured. In 2023, an estimated 26 million Americans lacked health insurance.
Racial and Ethnic Disparities
Uninsured rates vary significantly across racial and ethnic groups, with Hispanic and AIAN individuals facing disproportionately higher rates compared to White and Asian individuals, according to KFF.
Challenges with Medicaid and Medicare
Even with programs like Medicaid and Medicare, some individuals still struggle to find providers who accept their insurance, particularly in certain specialties like mental health, due to low reimbursement rates.
Access to Service Providers
Workforce Shortages
There are shortages of healthcare professionals in various areas, especially in behavioral health, making it difficult for individuals to find timely and appropriate care.
Geographic Distribution
Access to healthcare facilities and providers can vary significantly by location, with rural areas often facing shortages.
Timeliness of Care
Inadequate insurance coverage and provider shortages can lead to delays in receiving necessary medical care.
Policy Challenges
Complexity of the System
The US healthcare system is highly complex, with a mix of public and private insurance, and numerous regulations, making it difficult for individuals to navigate and access care.
Affordability
High costs of insurance, deductibles, copayments, and out-of-pocket expenses create significant financial barriers to accessing care, even for those with insurance.
Sustainability of Programs
The long-term sustainability of programs like Medicaid and Medicare is a concern, with debates about funding and coverage.
Environmental Regulations
Environmental laws and regulations for medical facilities, while necessary, can also add to the complexity and cost of healthcare.
Addressing the Issues:
Affordable Care Act
The ACA has played a role in expanding coverage, but further reforms are needed to address affordability and access issues.
Strengthening Safety Nets
Improving access to coverage through Medicaid and other safety net programs is crucial.
Addressing Workforce Shortages
Efforts to address shortages of healthcare professionals, particularly in underserved areas, are essential.
Improving Affordability
Policy changes to reduce the cost of insurance, deductibles, and out-of-pocket expenses are needed.
Promoting Health Equity
Efforts to address racial and ethnic disparities in insurance coverage and access to care are critical.
Lack of Providers and Services
When viewing the U.S. health-care system from an individual perspective, three reasons can account for an inability to access the system:
1) living in an area with inadequate services,
2) lack of health insurance, and
3) cost prohibitions for those with health insurance as a result of out-of-pocket expenses (e.g., deductibles, co-payments) (Davidson, 2013).
Directly related to the issue of access to care is an inadequate supply of health care providers and other health-care professionals as well as hospitals and facilities in certain areas. Most of these supply issues occur in rural areas (Davidson, 2013). The “availability of providers and services, coverage, benefits and affordability all come into play as potential explanations for different user experiences with the health care system and the outcomes attained” (Docteur & Berenson, 2009, p. 2).
Shortages of health professionals exist in all states, including urban areas. The Health Resources and Services Administration (HRSA) defines health professional shortage areas (HPSAs) as “areas or populations designated by HRSA as having too few primary care providers, high infant mortality, high poverty or a high elderly population” (HRSA, n.d.).
Lack of Health Insurance and Insurance With Limited Income
Before the implementation of the ACA, 32 million people in the United States lacked health insurance even though many worked multiple jobs or full-time jobs (Jacobs & Skocpol, 2012). Millions of other individuals had health insurance but were considered underinsured. Out-of-pocket costs for the underinsured were estimated at 29.1% of total health-care costs in the United States in 2009 (Davidson, 2013).
The number of uninsured persons in 2013 rose to 42 million (Smith & Medalia, 2014). In the first half of 2014, the rate of the uninsured among adults 18 to 65 years of age decreased substantially. The ACA is credited with this decline (AHRQ, 2015). Although the ACA mandated that residents within the United States have health insurance or face a tax imposed by the Internal Revenue Service, the cost of health insurance for those who did not qualify for a health-care tax subsidy remained an obstacle for many persons, especially those not receiving health-care benefits through an employer.
The percentage of persons receiving health insurance through their employer was 53.9% in 2013 (Smith & Medalia, 2014). Individuals are often blamed for their own circumstances, including their inability to have an adequate income or to find better employment to obtain adequate health insurance. They are often stigmatized for health issues that could be managed by exercise and other lifestyle decisions (Davidson, 2013), yet the OECD found that the health-care system fell short with regard to incorporating these recommendations in primary care (OECD, 2015).
Frequently, this is an example of the influence of social determinants of health that consist of patients’ lifestyles and incorporate their social and physical environment. Lifestyle and environment are then modified by patients’ access to public health services and medical and mental health care. Individual responses to these determinants interact with human biology to influence overall health status further (Arah et al., 2006). These individuals may be powerless to facilitate the changes necessary to overcome these obstacles and collectively have little support to facilitate change within the system.
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