Impact of Uninsured Population, Research Paper Example

Introduction

Nowadays, in the context of the 21^st century when living standards are considerably higher than several centuries ago, people experience freedom and recognition of all inherent rights and have multiple opportunities in their society, there is still much unpleasant and abnormal about which people prefer to keep silence. Even under the conditions of advanced, developed medicine millions of people who are citizens of the most developed, democratic countries may have no chance to receive health care for some reasons, which is a burning problem in many leading countries of the world. It is true that the state of healthcare services in the USA is nearly perfect, with all necessary equipment and medications available for the vast groups of population. Those who have insurance may turn to their hospitals being sure that all services will be rendered to them, they will get all necessary help and will recover. But what should be done to those who are uninsured, and how does the government deal with them?

Uninsured population portion is indisputably growing, so the situation needs to be thoroughly considered with the proper account of the previous influences it used to produce on healthcare institutions and the future outcomes that can be foreseen in the near future. The representatives of this group of population face the stigmatized attitude, being urged to fight against stereotypes and maltreatment, so a set of initiatives is essential to change the situation and to deal with uninsured and underinsured representatives of the US population more adequately.

Impact on Community Health Support Service and Relationships with Stakeholders

The financial burden that the uninsured bring to the medical care is constantly growing, and there is no chance for improvement – by 2013 every 1 in 4 Americans of non-elderly population is projected to become uninsured (MedAssist White Paper, n.d.). So how can the community health support system react to the change to remain financially sustainable and not to overload physicians as well as not to allocate scarce resources to cover costs for patients who will not pay this money back?

The MedAssist Company fairly thinks that the issue cannot be solved in one department – it is a comprehensive, ongoing process that should affect the whole healthcare system. It suggests that the overall system of healthcare coverage should be reformed in a number of ways to make the community health support system fit the urgent needs of hospitals (MedAssist White Paper, n.d.).

The first change it should undergo is to determine potential eligibility early due to capturing the needed information. The reason for this is that as soon as the patient leaves the hospital, hope for getting a refund shrinks. But if the community health support system allowed detecting the patient’s eligibility for welfare healthcare programs during his or her stay in hospital, then the percentage of coverage would substantially grow (MedAssist White Paper, n.d.).

The MedAssist Company also notes that the emergency room is the most vulnerable component of the community health support system, so substantial improvement can be achieved with the help of a “rules based, eligibility screening software that takes the guesswork out of determining and preparing applications for government medical assistance programs, hospital charity and other social program eligibility” ((MedAssist White Paper, n.d.).

If the computerized approach is introduced, then it will be possible to make the patient enrolled in the charity program while still in the hospital (MedAssist White Paper, n.d.).

Paying bills is a highly undesirable procedure, especially for the uninsured and low-income groups of population. For this reason many of them leave hospitals without paying their accounts, which reduces revenues of the hospital enormously. Consequently, among possible changes that the community health support system should introduce is the offer of deposits, payment plans or low interest medical credit cards, which will enlarge the number of options for the uninsured (MedAssist White Paper, n.d.).

Finally, the very culture of rendering healthcare services in the community health support system should be reformed – the patient and his/her dignity should be placed as a core value, thus reducing the negative connotation of the word ‘uninsured’ and helping patients overcome their hostility and abuse as a natural reaction to such socially formed stigmas. If this goal is achieved, more cooperation will be awaited from uninsured patients, which will surely benefit the community health support system on the whole (MedAssist White Paper, n.d.).

As for communication with key stakeholders, it is easy to predict the outcome of the uninsured population impact. Stakeholders are interested in proper financing and proper allocation of resources, but in case those resources are spent on the uninsured, and the coverage of such expenses is low as compared to the level of healthcare services rendered, this situation will cause an inevitable conflict and may discourage some stakeholders from further financing in healthcare.

The Observed Tendencies of Uninsured Population for the Past 5 Years

Tendencies observed in the USA within the last several years are very diverse, but still every year showed a significant increase of the uninsured population percentage, the only difference was in the prevailing groups that turned out to be more vulnerable at this or that particular moment of time. Thus, for example, the situation for 2008 was as follows:

“The Census Bureau found that as of 2008, there were 46.3 million uninsured Americans-an increase of 682,000 uninsured from the 2007 number of 45.7 million.  The overall uninsured rate rose only slightly, from 15.3 percent to 15.4 percent” (Census Uninsured Data, 2009).

Besides the statistical data on the number of uninsured people it is possible to use the research of Irvin, Fox and Pothoven (2003) who released their data on financial impact of the uninsured population:

“The 29 hospitals represented 1,146,280 ED visits yearly (31% of the total state ED visits). The hospitals served an average uninsured population of 11.1% (95% confidence interval [CI] 10.7% to 13.3%), with average collection per uninsured patient of $16.50 (95% CI $12.87 to $20.12)… the total nonreimbursement per uninsured patient was $77.15 (range $73.53 to $80.78) and $61.81 (range $58.19 to $65.44), respectively”.

As it can be seen from the extended quotation, the impact of uninsured population was tremendous according to the 2003 results, and the further tendency showed the increase in the overall numbers of uninsured population in the US, so it is possible to state that the figures continued to grow.

The Range of Possible Outcomes of Uninsured Population Growth

The first outcome that comes to mind speaking about the effect that can be produced by uninsured population growth on healthcare institutions is the growing pressure on the emergency department experienced by all institutions – in accordance with the federal law, all uninsured people whose state of health is in emergency, when they have a serious trauma or worsening of some diseases, have the right to turn to the emergency department (ED) for help without any payment. As it has been shown in practice for many years, people are not willing to pay regular insurance costs without extreme necessity, but as soon as their state of health worsens, then they visit the ED and receive help necessary (Miller and Joint Commission Resources, 2006).

The worst outcome of being uninsured is that those categories of population do not receive preventive care, which may lead to aggravation of diseases and emergence of serious, long-term affects on health both for adults and children. The same can be said about diagnosing incurable diseases and postponing the examination until the moment when little can be done to correct the situation, e.g. diabetes, cancer or pneumonia (Key Facts: Medicaid and the Uninsured, 2003).

The last but not the least, it is necessary to mention the figures that witness the growing financial burden of the uninsured both on the state and on all separate hospitals rendering their services to the uninsured. According to statistics, these figures are really shocking, and they are not likely to fall:

“The state estimate for non-reimbursed care to the uninsured was $31,717,000 per year (range $30,227,000 to $33,208,000) according to the Medicare fee schedule and $25,408,000 per year (range $23,921,000 to $26,902,000) according to Medicaid estimations” (Irvin, Fox and Pothoven, 2003).

The outcome of further growth of uninsured population for the near future is highly predictable – financing of hospitals will become scarce if the resources are allocated for catering for the uninsured. This will mean that the sources will become truly finite even for those who are paid clients, which is an unacceptable situation.

The Ability of Healthcare Institutions to React to the Change

It is surely hard to estimate the measure of readiness of every separate medical institution to the change and to assess its ability to react to uninsured population increase because of the individual profile of every organization. However, it is still possible to predict that no medical institution will benefit from such a tendency. Since the maximum operational pressure appears to shift to the ED, it will be necessary to employ more staff there and to provide more medical capacities to cater for the uninsured patients, the number of who can never be predicted precisely (Miller and Joint Commission Resources, 2006).

Surely, a medical institution would be able to respond to the change, but only under the condition of additional financing. If the government recognizes the problem in a timely manner and manages to react to the challenge efficiently, it will be possible to handle the change by medical organizations in a painless and constructive way. However, it is still necessary to raise the point of financing on the federal level as only this way the problem may be handled efficiently (Miller and Joint Commission Resources, 2006).

The second issue that may be discussed is the leader/management willingness to commit to organizational enhancement – even under the conditions of sufficient financing and absence of visible challenges to changing the structure of the institution to cater for the needs of the majority of those needing this, there is likely to be a challenge at the top of hospital management, while those used to the ordinary, accustomed state of affairs may reject the necessity to change anything.

Unfortunately, there is too much bureaucracy and formalism in medical institutions, so the problem may become really serious if there is no goals alignment in the top management and some members of the administration staff object to the change. In this case optimization of internal services that may lead to maximization of healthcare services for the uninsured provision is likely to fail because of the unwillingness of the staff to work for those who do not pay them. This challenge may be overcome only on the level of corporate culture.

Conclusion

Surely, the modern health care comes to the point when it urgently seeks improvement and reforming because of the growing percentage of the uninsured. People lose their medical insurance for a set or reasons that do not necessarily suppose their belonging to problematic or low-income categories of the US population, which is a stereotype. However, in the current state of affairs when the number of uninsured people is growing but they still come to hospitals seeking medical care, the overall medical care system should evolve to fit the changing needs of the population, to sustain an adequate level of service quality and to reduce expenditures resulting from non-coverage of costs for medical care by the uninsured. To achieve this goal, a set of actions should be taken to ensure the speed of enrolment for charity programs, to change the procedure of bill payment and to change the in-depth culture of doctor-patient relations to reduce the tension for uninsured patients.

All these actions should be taken simultaneously because the single action in a single sphere will never help. The community health support system and the emergency department are the most vulnerable components of health care that need substantial change and improvement, so only under the conditions of joint and comprehensive action it will be possible to make the renewed system work.

References

Census Uninsured Data (2009). Policy News. Retrieved January 11, 2010, from http://www.gop.gov/policy-news/09/09/10/census-uninsured-data

Irvin, C., Fox, J., & Pothoven, K. (2003). Financial impact on emergency physicians for nonreimbursed care for the uninsured. Annals of Emergency Medicine, Vol. 42, Iss. 4, pp. 571-576.

Kaiser Commission (2003). ‘On Key Facts: Medicaid and the Uninsured’. Retrieved January 11, 2010, from http://www.kff.org/uninsured/loader.cfm?url=/commo nspot/security/getfile.cfm&PageID=14185

MedAssist White Paper (n.d.). Retrieved January 22, 2010, from http://www.medas sist.biz/pdf/UninsuredMedAssistWP01.pdf

Miller, K.M., & Joint Commission Resources, Inc. (2006). Planning, design, and construction of health care facilities. Joint Commission Resources.