Application of Public Health Concepts for the Uninsured

Application of Public Health Concepts for the Uninsured: The Effects on the Health Sector
Introduction
Application of public health is of major concern to DNP-prepared nurses in their different fields and places of practice. Since the 20th century, public health nurses have been at the forefront of improving the general health condition of different communities by providing unrelenting and selfless services to members of the public. Immunizations, workplace safety, healthier mothers and babies, family planning, and awareness campaign on tobacco health complications are some of the critical areas they have immensely impacted (“The Unique Contribution”). In this present age, top amongst the global health concerns in DNP area of study is the growing number of insured people in the world. The prevalence of life-threatening and disability-causing diseases in society has made having health insurance a necessity. According to World Health Organization (WHO), Ischemic heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections and Alzheimer disease and other dementias are some of the top ten global causes of death. The world health body further revealed that out of “the 56.9 million deaths worldwide in 2016, more than half (54%) were due to the top 10 causes” (“Top Ten Cause 2018”).
Problem Statement
Unfortunately, the lack of health insurance has limited many people’s access to adequate healthcare needed to fight the diseases and live a healthy life. In the United States of America, for instance, according to the United States Census Bureau, 28.5 million U.S. residents lacked health coverage (Berchick, Hood & Barnett 2018, p. 1). This situation is not peculiar to the U.S.; it is a global problem which is even worse in developing and low-income countries. Lack of health insurance affects every stratum of national life, especially the economy. The effects, therefore, are felt on the uninsured, the insured and governments at all levels. To this end, it is imperative, therefore, to critically evaluate the effects of the public health concept of the uninsured in the country and propose a result-oriented initiative to resolve the problem.
Literature Review
To have a broad perspective of the effects of this national issue, two reports by reputable health organizations will be revisited. The Institute of Medicine IOM and Kaiser Commission Reports are some of the leading studies that give insights into the increasing rate of the insured population in the country and its negative impacts on the health sector.
In Kaiser’s Key Facts about the Uninsured Population (2018), the publication showed the number of uninsured and the major reasons for their lack of coverage. In addition, it analyzed the effects of lack of insurance, which include low access to healthcare and affordability problem. According to the report, during the economic recession between 2008 and 2010, the number of uninsured nonelderly people rose from 44.2 million to 46.5 million (“Key Facts about” 2018, p. 1). However, the figure was drastically reduced at the commencement of the Affordable Care Act (ACA), which was set up for health coverage expansion especially among low-income earners. However, for the first time since the 2014 commencement of ACA, the number of uninsured increased by more than half a million in 2017. Top among the reasons why people remained uninsured are cost of insurance policy and unemployment. For instance, 45%, 22% and 11% of nonelderly attributed their un-insured status to high cost, loss of a job or changed employers, and loss of Medicaid respectively. Other causes were status change (11%), and ineligibility for coverage (9%). (“Key Facts about” 2018, p. 2).
In the same vein, the IOM report, “America’s Uninsured Crisis: Consequences for Health and Health Care” (2009), also showed uninsurance crises in the U.S. The study provided answers to three key questions which were: What are the dynamics driving downward trends in health insurance coverage? Is being uninsured harmful to the health of children and adults? Are insured people affected by high rates of uninsured in their communities? (“America’s Uninsured Crisis" 2009, p. 1) It showed the stark differences in the level of uninsured across communities in the U.S. In 2007, for instance, uninsurance rate in a state like Massachusetts was as low as 6% while in Texas, it stood at 28%. Furthermore, comparison across zip codes in Los Angeles revealed that "the rates in the nonelderly population in 2005 ranged from 6 per cent to 45 per cent (“America’s Uninsured Crisis" 2009, p. 4). The disparity is a clear indication that while efforts by the federal government have paid off in reducing the total number of the uninsured in the country, the reality, however, is that many states, counties, and communities are still being left behind.
Impacts of Low Health Coverage: A Case Study
To explicitly divulge the impact of the increasing number of the uninsured in society, the Kaiser Commission report presented different case studies that bother on the connection between the low coverage rate and the health sector. One of the case studies was that of the three-hospital closure that happened in 2015: Mercy Hospital in Independence, Kansas; Parkway Regional Hospital in Fulton, Kentucky; and Marlboro Park Hospital in Bennettsville, South Carolina (Wishner, Solleveld, Rudowitz and Antonisse 2016, p. 2). It was stated that two out of the three closed hospitals were located in states (Kansas and South Carolina) where Medicaid coverage expansion under the Affordable Care Act (ACA) was not adopted. It further depicted the major factors responsible for the closure to include “high uninsured rates and a payer mix dominated by Medicare and Medicaid, economic challenges in the community and ageing facilities” (Wishner, Solleveld, Rudowitz and Antonisse 2016, p. 1). With such an unpleasant outcome, it is safe to conclude that the impact of the government decision and corporate bodies' initiatives about the healthcare of their community members cannot be overemphasized.
Findings of the Studies: The Disparity in Access to Health Care
The findings in the two reports clearly depict the outcome of the dwindling embracement of health coverage in the society. For instance, the aftermath of the hospital closures discussed above, worsened the pre-existing medical challenges in the communities as outmigration of health care professionals unsurprisingly followed the closures. For members of these communities, accessing healthcare afterwards will require transportation to neighboring communities - a task that might be challenging to the elderly and low-income earners (Wishner, Solleveld, Rudowitz and Antonisse 2016, p. 7).
Similarly, the IOM report also showed the effects of top life-threatening diseases on the uninsured members of the public. For instance, discussing the prevalence of acute ischemic stroke, the study in its finding asserted that “uninsured adults are more likely than insured adults to suffer extremely poor outcomes, including neurological impairment, intracerebral hemorrhage, and death” (“America’s Uninsured Crisis" 2009, p. 3). Also, for cancer, congestive heart failure, diabetes, heart attack, hypertension and serious injury or trauma, it was stated that the uninsured adults stand the higher risk of being diagnosed of most of these diseases than the insured (“America’s Uninsured Crisis" 2009, p. 3). .
Furthermore, the IOM report posited that a high rate of uninsured in any community will make even the insured members of the community have difficulties in getting the needed health care. It was stated that low level of health coverage does not affect communities the same way, however, the effect, regardless of its enormity, is not limited only to the uninsured (“America’s Uninsured Crisis" 2009, p. 4).
Other findings in the Kaiser report include the lack of access to health care by the uninsured. As reported by the study, 20% of the uninsured nonelderly adults went a whole year without preventive care because of cost. Many of them did not get the right treatments their health needed. For instance, “uninsured nonelderly adults were more than three times (19% vs. 6%) as likely as adults with private coverage to say that they postponed or did not get a needed prescription drug due to cost” (“Key Facts about” 2018, p. 7). Financially, uninsured people usually face the problem of affordability of medic care. Drawing a comparison between the insured and uninsured adults, the report thus showed: 29% to 14% had problems paying or unable to pay bills; 61% to 27% worried about being able to pay the cost for normal care; and 76% to 45% worried about paying medical bills if get sick (“Key Facts about” 2018, p. 8).
Summary of the Studies
Economic factors remain major reason for low or dwindling health coverage rate in the country, and the impact has already reached a crescendo in the health sector. Work experience, educational attainment and household income are key determinants in the country’s health coverage rate. For example, in 2017, while 84.4% of full-time workers had private health coverage, only 49.7% of non-workers did (Berchick, Hood & Barnett 2018, p. 11). Also, “the private health insurance coverage rate for people in households with income of $25,000 to $49,999 was 21.0 percentage points higher than the rate for people in households with income below $25,000” (Berchick, Hood & Barnett 2018, p. 11).
The disparities in affordability and access to medical care between the insured and uninsured have made health coverage a necessity that cannot be treated as an afterthought any further. As shown in the IOM report, the milestones covered at the national level were being diminished by the low response at state and community levels. Therefore, there is a need to shift attention to cities and counties that are still largely affected. More states are required to adopt and expand Medicaid under the ACA.
Limitations of the Studies and Proposed Future Study
However, beyond the scope of the uninsured versus insured people, a worthy consideration should be given to the category of underinsured people. While the two reports are very instructive in their analysis and data presentations on the effects of uninsured in the health sector, the underinsurance in the country also needs to be looked into. There still exist in the country, a good number of insured but underinsured individuals. This set of people might have health coverage but their health insurance offers very limited financial protection. It is not enough to only have health coverage; an insurance policy must be suitable and protective enough to provide coverage during any form of health challenges. Due to lack of data, it has hitherto been difficult representing and arguing this cause in public discourses. The context of health coverage representation henceforth should be approached from a three-prong perspective – the insured, the uninsured and the underinsured. Studies need to be carried out to substantiate the figure of this proposed demographic with the views to offer more robust and absolutely reliable health coverage that will be inclusive to all. It is, therefore, of utmost importance that the government, experts and policy analysts in health sector approach this with all sense of responsibility.
Recommended Research Instrument
To ensure the reliability of this proposed study, a qualitative research method should be employed. This research instrument will be the most suitable in this regard as it will accord the researchers the opportunity of one-on-one communication with the affected persons. With qualitative research method, there will be a near accurate data representation of the number of the underinsured not only in the country but at the community level.
Conclusion
The cases as presented in the reports showed that there is a need for action at all levels. Just as recommended by the IOM report committee, it is the responsibility of both the government and private sector leaders to intensify effort in achieving health insurance coverage to every member of the public. Living without health coverage is detrimental to people’s health. Without a pragmatic approach, low access to health care will continue to worsen the public health in the country.
References
America’s Uninsured Crisis: Consequences for Health and Health Care. REPORT?BRIEF (2009). Institute of Medicine, 1-6. http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/Americas-Uninsured-Crisis-Consequences-for-Health-and-Health-Care/Americas%20Uninsured%20Crisis%202009%20Report%20Brief.pdf
Berchick, E.R., Hood, E. And Barnett, J.C. (2018). Health Insurance Coverage in the United States: 2017. Current Population Reports. United States Census Bureau, U.S. Department of Commerce Economics and Statistics Administration, 1-35. https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf
Fact Sheet (2018). Key Facts about the Uninsured Population. Henry J Kaiser Family Foundation (KFF), 1-14. http://files.kff.org/attachment//fact-sheet-key-facts-about-the-uninsured-population
The Unique Contributions DNP-Prepared Nurses Bring to the Field of Public Health. Doctors of Nursing Practice DNP. https://www.doctorofnursingpracticednp.org/the-role-of-dnp-educated-nurses-in-public-health/
The top 10 causes of death (2018). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Wishner, Solleveld, Rudowitz and Antonisse (2016). A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies. Henry J Kaiser Family Foundation. Issue Brief. Medicaid and the Uninsured, 1-16. http://files.kff.org/attachment/issue-brief-a-look-at-rural-hospital-closures-and-implications-for-access-to-care