Impact of Uninsured Population

¶ … Uninsured Population

Healthcare

The health of a population is not only based on the strength of its health care professionals and diagnostic capabilities -- to a great extent, the health of a population is shaped by factors that exist outside of its health care system, this includes the health and well-being of the underinsured (Wakefield, 2010). Community health and its development require strong support networks and supportive social environments, education and a literate population, good working conditions, a stable physical environment and a strong culture, amongst other things. Together, these "Social Determinants of Health" are what shape the health of a population, and people should not be segregated in categories depending on their insurance (Mahar, 2010).

The overall risk to healthcare facilities will not increase substantially if the rate of uninsured continues to rise at the rate of 2-3% over the next five years. This is because of two reasons. Uninsured patients are either treated in emergency care or they are admitted to the hospital (Kaye, 2004). Even if the intake of uninsured patients increases in the emergency care by 2-3%, there will not be an increase in risk. Even if the entire emergency area is occupied by the uninsured and they do not pay, Healthcare facilities are capable to supporting the service. On the other hand when uninsured patients are admitted they have to make a down payment called advance payment. This payment is adjusted according to the charitable funds available with healthcare facilities. When there are no available funds, this advance can be increased to such an extent that it covers the entire estimated cost of treatment. The financial risk is reduced.

The overall risk in case of underinsured patients is high. Almost all insurance plans do not provide full coverage of the hospital bill. There are co-payments and deductibles that must be paid by patients when they are discharged (Kaye, 2004). With increasing number of underinsured persons, there are policy disputes, fee limitation, benefit reductions and out of network fines. Ordinarily, the policy of Healthcare facilities is that bills should be paid 10 days after the insurance payment is received. Still, the payment is required to be paid by the patient at the time of discharge. The business office of the Healthcare facilities stops patients at the time of discharge for the payment of their dues.

There are five key initiatives that will be discussed for meeting these risks. The first initiative is that the Healthcare facilities should increase its drive for donations so that it can bear the cost of unpaid bills related to the treatment of its patients. This increase is being recommended because of the anticipated increase in the percentage of uninsured and underinsured patients (Kaye, 2004). The second initiative is that State Government Grants should be applied for. The purpose of these funds will be to finance the cost of an increasing number of uninsured and underinsured patients. The third initiative is administrative in nature. Healthcare facilities business office should check with the insurance carrier the benefits the person gets from the policy before he is admitted. The business office should ask for an advance towards the uncovered portion of the insurance policy ("Improving Health Care," 2004). This will help reduce the risk of underinsured patients. The fourth initiative is that there should be fixed geographical area around the hospital from which uninsured and underinsured patients are accepted. This geographical limitation will not only limit the number of uninsured or underinsured patients that are treated at Healthcare facilities but will also ensure that is it relatively easy to collect debts from such persons.

The fifth initiative is that there should be collaboration with local clinics like the Raymond Bandy clinic where uninsured patients can be sent if the number of uninsured patients is very high.

The initiatives should detail the issue, the degree of risk, the internal and external environmental strengths and weaknesses, and your assessment of the ability of the organization to effectively respond to these risks (Kaye, 2004). The degree of risk is low in case of uninsured patients because they are required to make advance payment that covers their estimated costs. On the other hand the degree of risk in case of underinsured is high as the underinsured are required to make payments 10 days after the insurance company makes the payment or the day of discharge whichever is earlier. The basic risk is that the patient will not pay / not be able to pay the amount that he is supposed to pay.

In my opinion Healthcare facilities are well equipped to face the challenge of an increasing number of uninsured or underinsured patients. It has the internal strengths, the external facilities and the organization can effectively respond to the risks ("Improving Health Care," 2004).

The Healthcare facilities have the capacity to respond to an increased number of uninsured / underinsured persons. This can simply happen because of an increase in the population of Denton County (Tanner, 2007). There are two fronts on which response to change is possible. The main intake of uninsured patients is in the emergency rooms. The capacity of the emergency room can be increased to accommodate more patients. Currently there are five bed fast rack minor care area, this should be increased to eight beds, two full-service trauma rooms should be increased to four, two obstetrics/gynecology rooms need to be increased to four and the two cardiac treatment rooms should be increased to six. There is no need to increase the all-private room, the uninsured cannot afford them.

The other front on which the Healthcare facilities can respond is to subsidize the unpaid portion of the underinsured/uninsured patients. The two methods that can be used to subsidize are increased donations or government grants. The other method of mitigating risks is to introduce a system of advance payment for the underinsured. If the patients are made to pay their estimated costs in advance, the risk of loss from non-payment by underinsured is reduced.