Application of Public Health Concepts for the Uninsured


Uninsured patients represent a target demographic of patients that do not have health coverage. The problem is high on the agenda because the United States is the only industrialized country that does not offer universal and all-encompassing health insurance to all people, and the coverage has been changing and deteriorating over the past decade. Public health is the context in which the exploration of the uninsured patients’ issues will be conducted because it implies all procedures targeted at preventing diseases, promoting health, and prolonging life through an organized effort and informed choices that societies make.

Thus, the problem statement for the current research refers to the increasing health consequences for uninsured patients, such as the inequities in health care access, increased mortality that can be avoided, financial burdens, and the poor quality of care. Possible solutions are associated with overcoming the financial and healthcare burden of uninsured patients by applying the perspective of public health concepts. Key concepts that will be applied in the exploration of healthcare issues associated with uninsured patients include risk factors, education, and health care justice.

Literature Review

The Kaiser Family Foundation (2017) provided an extensive look at the issues of the uninsured American population. The introduction of the “Affordable Care Act (ACA) made a significant change in the healthcare insurance coverage and reduced the number of uninsured non-elderly patients from 44 million to 28 million” by the end of 2016 (Kaiser Family Foundation, 2017, para. 3). Thus, the importance of the ACA should not be overlooked because of its significant contribution to expanding health care coverage to adults who live at or below the 138% of poverty those states that contributed to the expansion of their coverage of Medicaid and provided tax credits to patients that managed to purchase their insurance through a marketplace. However, millions of people continue being uninsured, which is a problem that remains to be addressed.

When it comes to the reasons why people remain uninsured, employment is among the most persistent reasons. While most adult (non-elderly) individuals get their health care insurance through their employers, not all of them are offered that coverage or, if offered, have the funds to afford to pay for premiums. Due to the limitations of the eligibility for Medicaid that exist in some states, it is understandable why not many people can afford to purchase health insurance without the financial assistance of their employers. Thus, the cost is the largest limitation that prevents patients from getting insurance. However, the Kaiser Family Foundation (2017) report also mentioned such issues as the changes in access to health coverage associated with changes in people’s situations, the lack of availability of work-related insurance for all individuals, and limitations in the eligibility for Medicaid.

DeVoe (2013) explored the role of medical homes in treating the health issues of the uninsured. The researcher investigated the issue because the majority of ambulatory care clinics are usually not involved in helping patients get their health care insurance and retain their coverage, which contributes to the expanding magnitude of the problem. It was discovered that in the context of public health, a team-based approach that focused on prior planning was needed. For instance, when an individual has a specific health condition that needs to be addressed, but his or her insurance has a high annual deductible, it may be a good solution to proceed with treatment at the end of the year. When it comes to addressing the problem of patients that do not have any insurance, DeVoe (2013) suggested supporting the use of health information technology tools and patient registries for documenting the number of patients claiming to have no insurance. This can allow for the better management of patient data as well as monitoring the fluctuations in the rates of uninsured patients.

Within the context of public health, the concept of risk factors should be discussed. Smalley, Warren, and Klibert (2012) studied health risk behaviors in uninsured and insured community health center patients. Their research is important because it illustrated differences in health risk behaviors between the two groups. For instance, uninsured patients showed an increased prevalence of talking on their phone and/or texting when driving, were more likely to engage in unprotected sexual activities, “more likely to drink excessive amounts of alcohol, and more likely not to contact a healthcare provider in case of an illness” (Smalley et al., 2012, p. 1). The high levels of behavioral risk-taking among uninsured patients point to the issue of the lack of traditional public health education failing to prevent harmful acts that adversely affect patients’ health. Moreover, the fact that uninsured patients do not exhibit healthy behaviors may be linked to context-specific issues with which they deal, suggesting the need for exploring them further.

Decker, Kostova, Kenney, and Long (2013) found that in comparison with patients enrolled in Medicaid, uninsured individuals were less likely to suffer from obesity, live sedentary lifestyles, and had physical, emotional, or mental limitations. Also, it was shown that the uninsured had a lower prevalence rate of having chronic conditions. Although, if they had such conditions as hypertension, diabetes, or others, they were less likely to know about them and get their health under control. Despite the fact that compared to insured patients eligible for Medicaid enrollment, uninsured adults have a lower prevalence of chronic illnesses, their control efforts are inefficient and thus needed intensive medical care.

Theoretical Description of the Problem

Public health theories are concerned with exploring behaviors and behavioral changes that have been subjected to both interventions and academic research. In addition, efforts targeted at understanding inequalities in health care access and delivery point to structural issues while failing to illustrate how the limitations may translate into the daily lives of different population sectors (Blue, Shove, Carmona, & Kelly, 2014). Thus, most research and work in the sphere of public health have been targeted at changing unhealthy behaviors in an effort to reduce the occurrence of lifestyle-associated diseases.

The uninsured are of particular concern in regard to public health theories because they not only require assistance in changing their behaviors but also need the support of the healthcare sphere through the expansion of access to services. Theories of social justice go hand-in-hand with the problem of medically uninsured patients due to the presence of disparate health outcomes that adverse patients’ health. This means that the persistent efforts of examining social justice issues inherent to the problem of uninsured patients are needed, especially from the perspective of feminist and libertarian theories.

Discussion

With the continuous advances and updates made in the sphere of healthcare to improve the efficiency of medical interventions, Americans expect both improved overall health as well as extended life expectancy. However, the gaps in insurance coverage prevent some patients from receiving the appropriate level of care to address their health conditions. Based on the findings from the literature, the application of public health concepts for the uninsured consists of two main aspects: managing the population’s behavior changes to reduce the risks of developing adverse health issues and addressing health disparities from the perspective of social justice.

On the one hand, researchers that contributed to the body of literature on the uninsured population have all agreed that in order to address the health care disparities, patient education was needed, especially in the context of improving their behaviors. On the other hand, the attention of policymakers was imperative for increasing the coverage of insurance services to cater to the underserved population. Altogether, innovative strategies for attaining fairness in the provision of insurance should be implemented to replace the traditional interventions that have previously never shown any success.

Case Summary

Risk factors, patient education, and health care justice are the three main public health concepts to be applied when dealing with uninsured patients. In terms of risk factors, smoking, excessive drinking, and engaging in other dangerous health behaviors are the main priorities of a successful prevention program to address the health outcomes of uninsured patients. Patient education is the main method for making sure that patients understand their harmful behaviors and reduce the occurrence of risk factors that deteriorate their health. Health care justice is a concept to be applied in terms of regulatory and policy changes to provide wider access to health care insurance for all underserved patients.

Since the problem has a wide scope and continues affecting populations considered not eligible for health insurance coverage, a special focus should be placed on combining policy changes to account for social justice with free educational programs that enhance the knowledge on how to avoid harmful and high-risk behaviors. As identified earlier, the problem of insurance coverage is closely related to the high costs of the service. While education will reduce the likelihood of uninsured patients developing short- or long-term health problems, a policy change to expand the coverage will be the most effective in making sure that all patients, regardless of their eligibility status, receive the appropriate level of care at affordable rates.

Solutions

Solutions targeted at addressing the issue of some populations remaining uninsured are associated with both education and policy changes to account for the justice of health care. First, it is proposed to make health insurance personalized and case-specific, which will be especially helpful because those who get health care coverage from their employers tend to be less considerate of the money spent on their treatment. If, for example, all employers substituted higher wages for insurance, thus allowing workers to purchase their policy based on their needs, this will mean that insurance would belong to workers rather than their employers. Second, the empowerment of non-physical medical professionals to boost competition in the market will make patients freer in choosing the health provider to fit their needs. Ranging from nurse practitioners to naturopaths, the scope of practice should be expanded to achieve justice and cater to the unique needs that different patients may have. Third, it is imperative to let states integrate their own adjustments to Medicaid in order to address the specific health care disparities that have been already studied and identified previously.

In terms of patient education, free counseling and mentoring sessions are proposed to increase awareness about harmful lifestyle practices and behaviors that lead to adverse health consequences, especially chronic conditions. As mentioned previously, smoking, drinking, and even texting and driving rates are higher for uninsured patients, and their control of chronic conditions was on a lower level compared to insured patients. Therefore, free education for those populations who have the least support in terms of social justice and engagement is a solution that will allow patients to be more aware of their healthcare needs. However, it should be mentioned that without changes in policies and the expansion of coverage, only education will not be sufficient enough.

Research Instrument Identification

As the most appropriate research instrument used for measuring the outcomes of the proposed solution, a survey was chosen. In social and health care research, surveys have been widely used to measure the attitudes of a population sample to the effectiveness of an intervention in which they participated. A sample of uninsured patients should be selected to measure their perceptions of their position without insurance prior to the intervention and survey them about whether education and policy changes expanded their access to health care and whether they got the insurance coverage they needed to address their needs.

In terms of surveying a large sample of patients, the selected research instrument may not be sufficient enough. However, if scholars choose a representative sample – by age, gender, race, ethnicity, and occupation, then a survey will be effective for identifying the true outcomes of a plan for an underserved population. It is imperative to pay special attention to patients of diverse populations that face particular disparities in insurance and health care access.

Conclusion

The fact that Americans still do not have universal health coverage leads to differences in outcomes as well as inequalities in the management and control of chronic conditions. The review of the literature on this topic revealed that cost was the largest limitation influencing the access of underserved populations, which means that a significant change in policies was needed to account for expanding the eligibility of all citizens for insurance coverage under the ACA. It was identified that uninsured individuals showed higher rates of unhealthy and high-risk behaviors but lower rates of chronic conditions. However, due to the unavailability of insurance coverage, these patients lack awareness of existing health conditions and thus cannot address them effectively or in a timely manner.

Policy change and free education for the uninsured were proposed as a two-tier solution to overcome the existing gaps and disparities and ensuring that individuals receive the desired level of health care. Importantly, the uninsured need to be better aware of the impact of their high-risk behaviors on long-term health, especially when costs of treatment are a problem for them. On a policy level, insurance coverage needs to be case-specific and individual to every person to avoid employers’ from owning the health insurance of their workers. Also, the scope of practice should expand to make it possible for people to choose the right healthcare provider who will fit their unique needs.

References

Blue, S., Shove, E., Carmona, C., & Kelly, M. P. (2014). Theories of practice and public health: Understanding (un)healthy practices. Critical Public health, 26(1), 36-50.

Decker, S. L., Kostova, D., Kenney, G. M., & Long, S. K. (2013). Health status, risk factors, and medical conditions among persons enrolled in Medicaid vs. uninsured low-income adults potentially eligible for Medicaid under the Affordable Care Act. JAMA, 309(24), 2579-2586.

DeVoe, J. E. (2013). Being uninsured is bad for your health: Can medical homes play a role in treating the uninsurance ailment? Annals of Family Medicine, 11(5), 473-476.

Kaiser Family Foundation. (2017). Key facts about the uninsured population. Web.

Smalley, K. B., Warren, J. C., & Klibert, J. J. (2012). Health risk behaviors in insured and uninsured rural patients. Rural and Remote Health, 12, 1-8.