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In light of the current healthcare controversies, access to healthcare in the U.S. remains the issue of the major concern. Apart from the fact that the country does not provide universal insurance coverage for everyone, thousands of the American and non-American citizens in the U.S. face barriers on their way to using even the basic set of healthcare services in the country. The reasons of these problems are many. While thousands of people in the U.S. experience healthcare disparities based on their race, ethnicity, social status, disability status, or related non-medical factors, the U.S. cannot decide whether access to healthcare is a privilege or a right. As a result, the current state of healthcare in the U.S. has already become notorious for its growing ineffectiveness, inconsistency, and unjustified costs.
The significance of the issue
Needless to say that access to healthcare contributes to the general improvement of health in society. In the same way, access to healthcare makes it possible to address the emerging health problems at earlier stages of sickness which, as a result, reduces the costs of healthcare, improves the wellbeing of citizens, and minimizes the risks of morbidity across different population layers. “Access to health care has been justified in economic terms through its benefits in improving the health of entire communities, leading to conditions that favor economic growth” (Gulliford & Morgan, 2003), and in this context access to healthcare stands as the critical component of the societal wellbeing, without which communities are likely to experience the deterioration of social standards. Unfortunately, until present, access to healthcare in the U.S. has been the least secure among the most affluent countries (Gulliford & Morgan, 2003), and access to healthcare in the U.S. remains the topic of the major social concern. The barriers to access are so many that one single healthcare reform cannot address them all. However, it is important to understand the reasons and drivers behind the lack of access to the basic health care services in the U.S.
Related Issues and Consequences
In 2006, 47 million people in the U.S. lacked insurance coverage compared to 445 million of uninsured in 2005 (Cancer, 2009). As a result, more than 25% of people with serious health conditions, including cancer, had to spend all their resources and personal savings to tackle the health challenges in their lives (Cancer, 2009). However, while the need for the state to cover serious and terminal health conditions like cancer or mental illness is questionable, access to the basic health care services in the U.S. remains the topic of the major social concern. On the one hand, the problem of access reflects the multitude of barriers which individuals face on their way to health care and, on the other hand, this very problem is associated with a whole range of far-reaching health and social consequences, which require attention of the state and federal authorities. The differences in access to healthcare, usually referred to as “healthcare disparities”, are widely recognized but are rarely addressed, creating a dilemma between healthcare being a privilege and healthcare being the basic human right. In its current state, healthcare in the U.S. is still a privilege which only a few can utilize to protect themselves from potential health complications and to address their health complaints at the early stages of sickness.
To begin with, race and ethnicity are fairly regarded as the two major issues in accessing health care in the United States. The current state of research confirms the limited access of ethnic minorities to health care compared with the host population (Hesselink, Verhoeff & Stronks, 2009). The lack of cultural competence, language problems, and the lack of affordable care equally contribute to the development of misbalanced attitudes toward ethnic and racial minorities in healthcare. As such, minorities often find it difficult or impossible to improve or at least to maintain their health condition by addressing minor health problems. That is why it is no longer surprising that ethnic and racial minorities in the U.S. are characterized by the higher prevalence of serious and terminal health conditions – with the access to health care services restricted, they cannot attend regular medical examinations and are thus unable to detect, define, and reduce the scope of health complications at the earliest stages of disease. For example, in California alone, thousands of Hispanic men experience difficulties with accessing regular prostate-specific antigen testing, which means that these men are likely to address health services at later stages of sickness, causing higher costs and serious health complications (Miller et al, 2008). In the same way, racial and ethnic disparities in surgical care are not uncommon, and even when racially and ethnically diverse patients are insured through Medicare they have fewer chances to obtain the necessary surgical services, including coronary angiography, coronary interventions, or coronary artery bypass surgery (Ayanian, 2008). As a result, access to healthcare in the U.S. does not simply imply a possibility for patients to enter the system, but the extent to which they can consume the necessary amount of medical services. The lack of access to healthcare implies that patients are (a) either unable to enter healthcare or (b) fail to utilize the whole range of medical services which they need based on their health condition (coronary interventions is the brightest example of this issue). However, race and ethnicity are not the only problems in the current health care system. More often than not, social disparities and social class determinants become the relevance predictors of the limited access to health care services.
That social class, poverty, and the lack of available financial resources can create obstacles on one’s way to using even the basic health care services, hardly anyone can deny. For example, immigrant communities and refugees, who temporarily or permanently reside in the U.S., are included into the list of the most vulnerable populations, for whom health care and medical services are rarely or never available. Morris et al (2009) write that the majority of refugees do not access health care services at all, while many of them also experience the major language and communication issues and are thus unable to properly utilize the range of health services that are available to them. The lack of communication and language skills in refugees make it impossible for them to find a health service they need and even to read a medical prescription given by the physician (Morris et al, 2009). Given that these populations are at the highest risks of chronic diseases and health complications, the lack of access to medical services leads to numerous irreversible health consequences, which distort the picture of health wellness in the U.S. and place the rest of the host population at risk of serious health problems.
In many aspects, immigrants find themselves in the situation as difficult as those of refugees, and they can become the potential sources of risks and health threats to the rest of the American population. It is difficult not to agree to Nandi, Loue and Galea (2009) in that “access to health services is at the intersection of the health of uninsured immigrants and the general population and that extending access to healthcare to all residents of the U.S. is beneficial from a population health perspective.” Unfortunately, even in light of these findings and even given the growing awareness about healthcare access problems in the United States, citizenship and social status remain the two most probable predictors of health care access denial in the country. Despite the fact that access to healthcare among vulnerable populations is necessary to improve their health (Lee & Choi, 2009), and although such access is likely to result in the fewer emergency department visits and higher quality of prevention services (McQuire et al, 2009), the problems with access to healthcare persist and are unlikely to be resolved in the nearest future.
Although social status and racial/ ethnic characteristics are included into the list of the most probable predictors for health care access among the U.S. population, a multitude of other factors predetermines restricted access to even primary health care in the country. These may include the number of available medical specialists – according to Bristow et al (2009) the lack of ovarian cancer surgeons is directly responsible for the lack of professional quality ovarian cancer care in the country. Very often, employers become the reasons of the restricted access to healthcare, and based on different individual characteristics of enrollees, employers may regulate the amount and scope of available health services to particular groups of employees (Merrick et al, 2009). Disability is just another factor of problematic access to health care, and women and men with disabilities are likely to report the lack of access to a physician because of the high cost of medical services (Smith & Ruiz, 2009). And even mental health services can become a problem whenever clients face the need for professional mental health assistance (Shiner et al, 2009). Rural health disparities in the U.S. are not uncommon, too (AHRQ, 2004).
That the lack of access to health care services in the U.S. is the source of the major health is obvious. The concept of access to healthcare is at the intersection of health of uninsured vulnerable populations and population health concerns (Nandi, Loue & Galea, 2009). That means that restricted access of vulnerable populations to health care may lead to the development of mass health complications. Another potential consequences of the restricted access is in “shorter and more constrained lives – a dramatic example of this is that inadequate access to health care is thought to be the primary cause of the premature deaths of 100 million ‘missing women’ worldwide” (Anonymous, 2005). Finally, that not all U.S. residents have a chance to enter the healthcare system and to utilize the fullest scope of medical services makes it impossible for the United States to reduce the costs of healthcare in the country: problematic access to primary care leads to the increased hospitalization and the use of emergency services. Patient’s failure to address their health problems at the early stage leads to increased costs and reduces the chances to overcome the diagnosed health difficulties.
Proposals for Addressing the Issue
Whether healthcare is a privilege or the basic human right is still a matter of the hot social debate. On the one hand, universal coverage could provide vulnerable populations with the access to medical services. On the other hand, coverage alone cannot resolve all access problems, because vulnerable populations often experience cultural and language barriers on their way to healthcare. Recently, health care rationing has become a subject of the political and social discussion as a potential resolution to the current access problems in the U.S. (Rhodes, 1992). Unfortunately, there is no universal solution to the problems with healthcare in the U.S. It is obvious that all citizens should be granted with the right to access the basic primary services, which would include regular basic examinations as a matter of reducing further risk and health complications. Simultaneously, the U.S. should reconsider the structure of healthcare costs, which are annually spent to provide the American population with medical services. Only by reducing the costs of healthcare the latter will become available and accessible to everyone, while the state will release funds necessary to resolve related issues, including communication and language.
Prospects for the future
In its current state, and giving the complexity of the issue, the United States is unlikely to resolve the issue of access at once. Access to healthcare is associated with a whole range of related problems which were discussed in this paper. I believe that everything depends on how attentive we are to the quality and costs of national healthcare. I am also confident that to make healthcare accessible for everyone it is not enough to open the doors of hospitals and medical facilities to the vulnerable populations. To make this happen, everyone should have an insurance coverage, which is impossible without reducing the costs of healthcare. At the same time, insurance coverage cannot alone resolve these issues because it will not help different population groups learn the language and overcome cultural barriers. I am confident that primary health care should turn into the basic right, while accessibility of other, more complicated and expensive medical services will depend on the amount of benefits and insurance coverage status of patients. Such attitudes and approaches to healthcare will, on the one hand, help individuals detect their health problems early, and, on the other hand, will promote the principles of distributive justice in accessing health services in the U.S.