Term Paper: Health Disparities: Problem of the Uninsured

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[. . .] A physician compromises this principle by treating a patient negatively because of their choice of not taking coverage; but all the same, the physician has a duty to inform the patient of the probable consequences of their choices (Macklin, 2003).

Justice: a healthcare practitioner ought to treat all their patients in a fair manner (Macklin, 2003). This principle requires a practitioner to treat uninsured patients in the same way they would treat an insured one with a similar condition. The ANA supports the ongoing health reforms because of the current system's inability to accord the same standard of care to all patients. The principle that "all persons are entitled to ready access to affordable, high-quality health services" is a perfect representation of the justice principle (ANA, 2008, p. 5).

What Makes this an Ethical Issue?

The problem of the insured poses an ethical dilemma for the medical fraternity, as much as it does a financial challenge. A healthcare professional has a moral duty to care for all patients equally, with no discrimination; and there is no exception to this moral obligation. However, in the same light, is it really fair to provide 'free' care to a selected group, and then shift the cost to another group that lives in the same jurisdiction, and under the very same economic conditions? Well, an uninsured person could perhaps argue that this is some kind of distributive justice, where the rich help the poor cover some of their costs so that everyone leads a comfortable life, at the least. But then, are we really helping ourselves; is this a sustainable plan? If hospitals keep losing money by providing care to uninsured people who cannot afford it, won't there come a time when the expenses will be too high to match, and hospitals will have no choice but to close down, causing higher rates of unemployment and threatening the health of the entire community?

The American Nurses Association (ANA) has thrown its weight behind the uninsured, expressing that adverse selection is a principle not applicable to the heath sector. Speaking during a White House event in 2009, Rebecca Patton, President of ANA, expressed support for President Obama's Capitol Hill project of healthcare reform and reiterated the association's commitment to "the principle that healthcare is a human right and that all persons are entitled to ready access to affordable, high-quality health services" (ANA, 2008, P. 5). The Association does not blind itself to the fact that the uninsured impose an extra financial burden on the insured population; however, it refurbishes the popular belief that they overcrowd ER facilities, holding that most of them would not seek emergency department services unless they really are in a crisis situation.

However, ANA appears not to be the only association calling for healthcare reform. The American College of Emergency Physicians (ACEP) has also raised concern on the current system's ability to advance the same standard of care to every patient. In its 2013 factsheet, ACEP expresses that it is unfair for anyone to view the uninsured as a burden on the nation's emergency system because "emergency care is the safety net of the entire national health system, caring for anyone regardless of ability to pay or insurance status" (n.pag). This view has been reiterated by the Alliance for Health Reform (AHR), which posits that what the uninsured need is assistance and not seclusion, because after all, a community is only as healthy as its weakest member (Kumar, 2007). The organization thereto advocates for the development of a comprehensive insurance plan option that ensures access to services, fosters marketplace competition, increases affordability, and provides a broader choice for patients.

Coverage Features Do Matter

The research literature and the various organizations within the medical fraternity associate quality healthcare with comprehensive and continuous coverage. According to the AHR, intermittent coverage increases unmet medical needs, lowers the use of service, and makes it difficult for people to access care. This is in addition to the fact that it contributes "to health disparities for people with low educational attainment and for the poor" (Bernstein, Chollet & Peterson, 2010, p. 2). Furthermore, premature death is more common among the uninsured, and those whose coverage is non-continuous (Kumar, 2007). The AHR advocates for the development of an employer mandate requiring all employers with a certain minimum employee threshold to not only offer health coverage, but also pay a certain pre-determined proportion of the premiums; or to alternatively pay tax in support of a state-run insurance program, to which their employers can subscribe. The government could additionally offer individuals a tax credit for a part of their expenses, and employers a tax break for providing coverage (AHR, 2007).

The ANA, the AHR, and ACEP concur that there is need to reform the current system so that it provides universal health coverage in a target-based incremental manner. Some of the options being advocated for include allowing uninsured 50+ year olds to buy into Medicare; offering Medicaid to low-income adults without dependents; and allowing parents with eligible children to buy into the CHIP program. ANA has taken a leadership role in advocating for a comprehensive insurance plan that covers preventive services, prescription drugs and mental health services, and provides for affordable cost-sharing.

The Impact of a Large Uninsured Population

i) On Access to Care

Access to care basically means that individuals "have the financial and other means of obtaining healthcare services" (Code Red, 2006, p. 48). A large uninsured population impacts access to care in a number of ways.

Higher Costs of Health Insurance: the cost of health care services provided to uninsured patients every year is approximately $65 billion, 35% of which is usually settled out-of-pocket by the patients (Code Red, 2006). In this case, the remainder is mainly covered using two sources -- government programs (one-third), and insured people in the form of higher premiums (two-thirds) (Code Red, 2006). The states of Idaho, Arkansas, Alaska, Montana, West Virginia, Oklahoma, and Texas have the "highest amounts of added premiums due to unreimbursed costs of healthcare for the uninsured" (Code Red, 2006, p. 49). Today, a family with employer-sponsored coverage in Texas pays approximately $2.786 higher annually in insurance premiums due to the unreimbursed costs of the uninsured population (Code Red, 2006).

More Costly Health Services: healthcare providers nationally bear approximately 33% of the cost of healthcare services advanced those who are uninsured (per annum) (Code Red, 2006). In 2002 for instance, the cost incurred by hospitals nationally as a result of uncompensated care was a massive $22 billion (Code Red, 2006). This cost imposes an extra burden on a "system already struggling to meet increases in the demand for services resulting from demographic and reimbursement changes" (Code Red, 2006, p. 49). The number of admissions to Texas Hospital, for instance, rose from 1.9 million to 2.6 million between 1992 and 2003; and that of outpatient visits rose from 16 million to 35 million (Code Red, 2006). The demand is even higher now, thanks to the aging of the Baby Boomer generation. All these factors put a strain on the resource base, with the impact being felt in the unprecedented increase/rise of charity care and bad/doubtful debts, as well as the increased ER use (Code Red, 2006).

Overwhelmed Emergency Departments and More Frequent Diversions: there has been a substantial rise in emergency department utilization over the last two decades. A 1999 survey by the National Hospital Ambulatory Medical Care Institute found that the number of annual ED visits per a hundred persons rose from 36% to 37.8% between 1993 and 1999, whereas that of emergency departments rose by only 1%, from 5,507 to 5,769 (Code Red, 2006). 66% of hospital trauma centers were operating above their optimal capacity in 2010. It is no wonder, therefore, that the number of ER diversions has risen substantially, with 75 hospitals in the state of Texas alone diverting ambulances at least once in 2003 due to lack of staffed beds (Code Red, 2006). Attempts to increase capacities are often hampered by the fact that the funds advanced to offset the costs of uncompensated care are insufficient.

ii) On the Services of Healthcare Providers

A large uninsured population implies that a large amount of critical medical needs will not be met. Emerging trends indicate that more and more healthcare practitioners are becoming reluctant to offer adequate services to uninsured and underinsured individuals (Code Red, 2006). The Texas Medical Association tracks changes in care providers' practice behaviors every two years; in 2004, the association found that 6% of care providers in active practice had negative attitudes towards uninsured patients; 2% "reported refusing to take new uninsured patients;" and 67% reported not accepting new Medicaid patients (Code Red, 2006, p. 52).

iii) On the Economy

Significant economic consequences accrue to the families and employers of uninsured workers as a result of their "poorer health, greater disability, and premature death" (Bernstein, Chollet & Peterson, 2010, p. 2). The overall economy suffers as a result of… [END OF PREVIEW]

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Health Disparities: Problem of the Uninsured.  (2014, July 22).  Retrieved June 26, 2019, from https://www.essaytown.com/subjects/paper/health-disparities-problem-uninsured/1040523

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"Health Disparities: Problem of the Uninsured."  Essaytown.com.  July 22, 2014.  Accessed June 26, 2019.
https://www.essaytown.com/subjects/paper/health-disparities-problem-uninsured/1040523.