Access to Healthcare: a Critical Necessity for a Healthy Nation

ABSTRACT

According to Augustine Nduka, a healthy nation is a wealthy nation, and that means that the quality of healthcare services is one of the most critical necessities that determines a country’s well-being. Sadly, due to the current COVID-19 pandemic, healthcare in America is now being discussed almost every day. Millions of Americans are dying due to the current health crisis, and having access to health care can mean life or death for many people. Low-income Latinos have been hit the hardest by the current pandemic, and now more than ever they need the government to provide affordable and quality health services. Learning about the inequalities that these communities face motivated me to question why these health disparities exist and what the government needs to do to solve the problem?

It is generally agreed that the healthcare delivery system in the United States needs change, so it is not surprising that access to adequate and culturally competent healthcare services is an issue for low-income Latinos. Predictably, it is twice as hard for Latinos in underserved communities to thrive without suitable services. To understand how these barriers ensued, I will start by providing an overview of the U. S healthcare system in part I, in which I will also discuss the healthcare bills that formed the current system. Further, in Part II, I will discuss the barriers that Latinos in underserved communities face when trying to access affordable and culturally appropriate healthcare treatments. It is only by thoroughly understanding these problems and their causes that the government can begin to understand how to solve them. In part III, I will offer solutions such as the need for more Latino doctors in underserved communities and affordable health services.

In some areas of the U.S, Covid-19 is killing Latinos at up to three times the rate that it is killing white people. It is crucial for the government to do their best to save as many lives as they can by addressing Latinos health disparities in low-income communities. Latinos are predicted to become the largest minority in the U.S in 2050, which means they are a big part of our future population. Latinos will be a big percentage of the workforce. Therefore, it is crucial that the government understand the need to provide culturally appropriate services to underserved Latino communities to make sure that our future workforce is healthy and thriving. There are 60 million Latinos in the U. S right now and those that have a low-socioeconomic status deserve to have easy access to culturally appropriate healthcare services. All the people that are dying due to lack of care matter, and the government needs to have a productive approach to fix these disparities.

Introduction

Between 1959 and 2014, the United States experienced an unprecedented increase in life expectancy, which rose from 69.9 years to 78.9 years. The fact that the American population has added almost 10 years to its lifespan in that short amount of time is astonishing and a testament to the benefits of healthcare. The essential nature of healthcare becomes blatantly clear in emergency situations such as the Covid-19 pandemic. Medical facilities and personnel are needed to diagnose, treat, and manage different types of people and diseases.

Now more than ever, we can see the benefits of health care services and how they impact everyone in the country, especially those that have a low socio-economic status. In this paper, I will provide an overview of our current healthcare system and how it works. I will also discuss the barriers that are preventing Latinos from adequate health care services and the steps that we can take to solve these problems, such as more grants to increase the number of Latino doctors and training non-Latino doctors to provide culturally appropriate services.

While other researchers have discussed the importance of giving Latinos subsidized health insurance, these researchers have not mentioned the other issues that need to be addressed such as the shortage of Latino doctors, the need for more adequate health services in underserved communities, and how to properly advertise all the assistance programs available to those that need it in the Latino community. Although health services for undocumented Latinos is also a concern, it is outside of the scope of this research as we will be considering the healthcare system for Americans. The healthcare concerns of undocumented Latinos is a complex issue with different root causes and solutions.

Overview of the Health Care system in the U.S

Access to health care helps people meet their goals with longer, healthier, happier lives. The definition of healthcare is the same all around the world: it is a system that involves the maintenance and improvement of medical services to meet the medical demands of the people. In the U.S the growing demands of patients have been widely recognized, especially during the current Covid-19 pandemic as healthcare coverage remains critical to preventing and managing serious medical conditions. Health coverage provides access for individuals and families to seek preventive care and treatment when they need it, while keeping costs low. In this section, I will provide an overview of the history of the healthcare system in the U.S, the types of healthcare options and coverage, U.S healthcare spending, and the major healthcare legislation that created the healthcare system that we have today. Not only does healthcare policy affect the cost citizens must pay for care, but also their access to quality care can influence their overall health.

History of Health insurance

According to the Centers for Disease Control and Prevention (CDC), anyone born in the United States has a life expectancy of 78 years, an increase from 75.2 years in 1990. This increase in life expectancy is largely thanks to health care coverage. Unfortunately, in the early 1900s, health care was unregulated and health insurance was nonexistent. After World War I, the cost of health care was more expensive since hospitals and doctors began to increase the prices for their medical services, putting them out of reach for the average person. Back then, doctors treated their patients in their homes since the few hospitals that existed provided minimum care. Also, patients had to pay out-of-pocket fees and there was little that doctors could do to treat most diseases. As hospitals became the center of medical care delivery, it became apparent that many communities lacked adequate access to them, so the Hill-Burton Act was passed in 1946 to provide loans and grants for the construction of new hospitals and improvements in the existing ones. Later, the first nonprofit insurance company, known as the precursor to Blue Cross Blue Shield (BCBS), was created to help cover hospital services. Nowadays, it is one of the largest insurance providers in the country.

The basic structure of the American health care system is largely a result of one event, World War II, and the wage freezes and tax policy that emerged because of it. After World War II, countries began to regroup and decide how to provide health care to their citizens. Many countries saw government as the only entity capable of doing so since the businesses and economies were in ruin. However, the United States was in a different situation. Rather than relying on government to offer insurance, employer-sponsored health insurance became the norm. In 1942, the nation was facing a severe labor shortage. Economists feared that businesses would keep raising salaries to compete for workers, and that inflation would spiral out of control as the country came out of the depression. To prevent this, President Roosevelt signed the Stabilization Act of 1942 and prevented employers from offering higher salaries to attract or retain employees, but they could offer benefits such as insurance plans and health packages.

Then, in 1943, the Internal Revenue Service decided that employer-based health insurance should be exempt from taxation. This made it cheaper to get health insurance through a job than by other means. Entering the 1960s, the health care system was fiscally unrestrained. There were no external controls on the cost of medical therapies delivered or the resources consumed. There were, by then, more companies selling health insurance, yet people who were unemployed were having difficulty paying for it. This led Congress to create Medicaid in 1965 to provide public health coverage to poor families. The program was administered through matching grants, in which federal and state governments both provided funds. States were left some discretion over dispensing and determining eligibility for the program. Overnight, the federal government became the largest single purchaser of healthcare services and these two public programs accelerated the rate of healthcare price inflation.

The success of the Blue Cross and Blue Shield plans showed commercial insurers that they should focus on insuring groups of young, healthy, employed workers. Thus, the market for health insurance of all kinds increased dramatically during the 1940s, from a total enrollment of 20,662,000 in 1940 to 142,334,000 in 1950. In the 1970s there were 26 plans with about 3 million subscribers nationwide; by 1991 the numbers had grown to 556 plans with 35 million enrollees. The disparities in the low-income communities were still pervasive, so in 2002, President Bush launched Health Center Growth Initiative considerably expanding the number of community health centers serving the medically underserved.

How do people gain health care coverage?

Now, in the 21st Century, healthcare systems across the world are focusing policy efforts on improving the quality of healthcare delivered to their population. In the U.S, citizens can receive coverage through a mix of private insurance and various federal and state programs, employer-sponsored HMOs and PPOs, and individually purchased plans. It’s important to note that as of 2017, 150 million people had health insurance through an employer, 70 million through Medicaid, 50 million though Medicare, and the Affordable Care Act (ACA) covers around 17 million. The most popular source of obtaining health insurance in the U.S. is through employers; approximately 49 percent of the country’s total population receive employer-sponsored health insurance

Who operates healthcare facilities?

Healthcare facilities are largely owned and operated by private-sector businesses. Fifty-eight percent of community hospitals in the United States are non-profit, twenty-one percent are government-owned, twenty-one percent are for-profit, and the remainder are owned by state and local governments.

How does health care work?

When choosing a plan, it is a good idea to understand the current health insurance options in the United States. This includes Health Maintenance Organization HMO’s, Provider Organizations (PPO’s), and Obamacare. These plans differ in terms of pricing, mainly offering different fixed payments and pay-per-usage fees as well as flexibility in choosing doctors. Beyond the monthly premium and out-of-pocket costs, the deductible, how much one must spend for covered health services before the insurance company pays anything except free preventive services, should also be considered. Further, copayments are payments which are made each time one receives a medical service after reaching the deductible. Some policies provide for an out-of-pocket maximum, which is the most someone should spend for covered services in a year. After reaching this amount, the insurance company pays 100% for covered services. Most people under 65 obtain insurance through their or a family member’s employer, by purchasing health insurance on their own, or are uninsured. Health insurance for public sector employees is primarily provided by the government in its responsibility as employer.

Types of Health Insurance

The insurance industry has developed all kind of programs to protect consumers from the costs of ill health and to ensure they receive quality care. These include programs such as major medical insurance, HMOs, PPOs, POs and other programs to insure against the costs of medical care

Health Maintenance Organization (HMO)

In 1929, the Ross-Loos Medical Group had established a prepaid health plan that provided medical services to Los Angeles city and county employees for $1.50 a month. In retrospect, this is considered to be the first HMO (health maintenance organization). HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for HMO. It generally will not cover out-of-network care except in an emergency and often provide integrated care and focuses on prevention and wellness.

Preferred Provider Organization (PPO)

PPO plans are a type of health plan where one pays less if you providers in the plan’s network are used. Doctors, hospitals, and providers outside of the network can be used without a referral for an additional cost. PPO plans are more common than POS Plans. The PPO plan is a group of healthcare providers that offers health care services for employees. It is often sponsored through an insurance company, employer or other organizations. This allows them to offer discounted cost of healthcare for the group.

Point of Service (POS)

Point of Service (POS) is a type of plan where one pays less if doctors, hospitals, and other health care providers that belong to the plan’s network are used, POS plans require a referral from the primary care doctor to see a specialist. POS is a type of managed care plan that is a hybrid of HMO and PPO Plans. Like an HMO, participants designate an in-network physician to be their primary care provider. But like a PPO, patients may go outside of the provider network for health care services. When patients venture out of the network, they will have to pay most of the cost unless the primary care providers have made a referral to the out of network provider.

PART II

Underserved Latino Communities Need for Health Equity

In some areas of the U.S, Covid-19 is killing Latinos at up to three times the rate that it is killing white people. Unfortunately, for Latinos, this statistic is not a surprise, yet it now sheds light for all other Americans about pre-existing health inequalities among underserved Latino communities. U.S. health policies created before this pandemic set the stage for these inequalities and are contributing to unnecessary sickness and fear during this crisis. This is vital not only for the health of Latinos themselves, but also for the health of the public. In this section, I will specifically address the inability of low-income Latinos to afford high healthcare premiums, the low percentage of Latino doctors, and underserved communities' lack of knowledge regarding available aid which contributes to the health disparities.

Latinos in the U.S

Few ethnic groups have had as great an impact on the demography of the United States as Latinos. Today, the national Latino population number is 60 Million, representing 18% of the total population and making up 14% of the total US workforce. This makes them one of the largest minority groups and fastest growing in the United States. The current health crisis has exposed that Latinos are a high percentage of our essential workers, and they often have jobs that do not offer health benefits. It is important that those that are treating Latinos understand the culture that affects their behaviors, beliefs and expectations. This will allow the provider to help Latinos understand the cause of an illness and how to manage them as well as the consequences of medication and medical treatments. Culture also influences people’s expectations on healthcare delivery and relationship building. It is important for healthcare providers to understand and cope with all these differences as it affects the way people react to healthcare provision.

Lack of affordable health care coverage

For those that have access to it, the healthcare system in the United States is among the best in the world. However, affordable health care, quality and preventative services are not consistently accessible across the country. Latinos have the highest uninsured rate among any ethnic group within the U.S. In 2017, the Census Bureau reported that 49 percent of Latinos had private insurance coverage, as compared to 75 percent for non-Hispanic whites. This is a huge gap in health care coverage across ethnic groups. Due to lack of health insurance coverage, some Latinos delay healthcare treatment for an illness or stop treatment when symptoms disappear which can lead to deadly consequences for some. Sadly, having access to good health care coverage depends highly on your employment status, including occupation, and whether your employer can afford to provide health care. Two-thirds of all uninsured persons are members of lower-income families, this includes Latinos. This means that most must take jobs that do not offer health care, and pay low wages which make things like health care co-pays expensive and a luxury. Research by the U.S. Centers for Disease Control and Prevention has exposed that Latinos are twice as likely as blacks and three times as likely as whites to lack a regular healthcare provider, this lack of health insurance is associated with increased unmet health–care needs.

In addition, insurance policies are offering fewer benefits and higher co-payments and most healthcare providers require insurance coverage from their patients, or they charge a high fee that Latinos cannot afford. The lack of access to health services has life-threatening consequences for the Latino community, it contributes to poorer health status and higher rates of mortality due to the lack of preventive care, which leads to late detection of disease, and lack of consistent care. Managing a chronic illness, such as diabetes or asthma, for example, becomes much harder when you don’t have access to health care and the medications needed are too expensive. Research finds that the working American middle class-of which Latinos are a large part-has suffered the most from increases in health insurance premiums. To avoid paying rising health care costs, the employers of many middle-class workers are increasingly hiring on a contingent basis only. In fact, contingent workers currently account for 10% of the U.S. workforce and over 17% of all uninsured workers. That’s millions of Americans who lack coverage if they get sick from the coronavirus, at a time when Americans desperately need access to health care. The problems inherent in the U.S. system of health care are literally killing people.

The low number of Latino Health Care Providers

Currently, America has a shortage of doctors and an even bigger shortage of physicians of color. Between 1978 and 2008, only 5.5% of graduating doctors in the US were Latino which means that even though Latinos make up 17% of the US population, they only represent a portion of the doctor workforce. This low percentage of Hispanic doctors explains why some Latinos tend to feel awkward with the American style of healthcare. For many in the Latino community, a doctor-patient relationship needs to feel welcoming, and personal so the patient can feel/know they are receiving the best care possible. This makes the American healthcare setting, in which doctors often rush visits and lack time to establish relationships with patients, seem unreliable. Latino doctors are able to communicate effectively and provide adequate treatment to underserved Latino communities since they understand the culture, needs and expectations.

The Latino population continues to grow these disparities will continue to impact the nation. It is important that the government works on increasing access to preventative care, and care that is linguistically and culturally competent so that we can reverse this trend.

Lack of culturally appropriate healthcare services

As a nation, we have an abundance of healthcare facilities and cutting-edge technologies that are the envy of the world However, the availability of newer and improved health–care services, does not mean that they are equally available to all Americans. The disparity between Latinos and non-Latinos in health coverage forces Latinos to seek medical care from community clinics, or community hospitals. 19% of Latinos were uninsured in 2018 which means that most of those that are uninsured will seek cheaper treatment within their Community Clinics. However, If the community clinic they attend can’t offer the proper lifesaving procedure than complications and even death can occur. Nearly 6 in 10 Hispanic adults have had a difficult time communicating with a healthcare provider because of a language or cultural barrier. Latinos need welcoming facilities with diverse staff in their communities.

Latinos in the United States are disproportionately affected by barriers to healthcare. This Part summarized the factors that contribute to the lack of access faced by Latinos. Now it’s time for all of us, our governments and lawmakers to show compassion and take care of the communities that have put themselves on the line.

PART III

Targeted Health Services

In some areas of the U.S, Covid-19 is killing Latinos at up to three times the rate that it is killing white people. Now more than ever, it is crucial for the government to target disparities in Latino community’s health and to create a focused approach to solve those inequalities. There is no one-size-fits-all solution that works across all communities. Rather, interventions must be tailored to the community’s specific needs, and must mirror the community’s demographic and treatment preferences. In this section, I will offer solutions to enhance the Latino community’s access to high-quality health care. I propose, that the government funds subsidized health care programs, offer grants so that Latinos can go to medical school and creating adequate operating locations in underserved communities. By addressing these different areas the percentage of Latinos who received needed healthcare services will increase.

Fund Subsidized Health Coverage Programs

There is a high percent of Latinos that cannot afford healthcare. Major obstacles to healthcare access for Latinos should be addressed, particularly those originating from workers having low-income jobs with inadequate health benefits. I propose that congress provides funds affordable health coverage programs that target Latinos communities with a history of low health care accessibility. Accessibility and affordability are critical features needed for Latinos to enroll. State and federal governments must work with small business employers to provide health care for employers with a few staff. In this way, it is a win-win: employers also benefit as well as the employees. This will persuade them to offer coverage for their employees. Also, funding subsidized programs would benefit individuals who do not have access to employer-sponsored coverage or who cannot afford an employer-sponsored plan. Given Latino’s low rates of health insurance, subsidized health coverage programs will attract enrollment and will help increase the number of Latinos that have health insurance.

Healthcare field grants for Latinos

Increasing the number of Latino healthcare providers who can provide adequate services to the Latino community is needed. Spanish-speaking doctors have been shown to improve the control of diseases and improve patient’s obedience to health advice and patient satisfaction. To address the low number of Latino healthcare providers in the nation, scholarships should be provided to Latinos and non latinos that would like to serve in underserved Latino communities. The number of Latinos who applied to medical school has tripled over the past 30 years, however, the percentage of those who graduated hasn’t increased much in the past years. Latino students may not pursue a career in medicine due to having low socioeconomic status and this adds to the healthcare workforce gap. I suggest that the government triples the current funding for grants offered to Latinos seeking a career in health care, making it a requirement that after graduating the applicant must provide 3 years of services in an underrepresented Latino community. Some Latinos might have personal experiences with barriers that they had to overcome to get health care treatment; this experience will motivate them to go back to a low-income area and provide health treatment. The healthcare providers from the local community have a greater understanding of the social and physical issues facing the local community. The government needs to partner with underserved community clinics to find the areas that need Latino doctors the most. Strategies to solve disparities in care must engage the community

In order to increase medical school enrollment they need to make sure that they are spreading the word about the financial help they will offer those that are interested in becoming doctors and providing service in an underserved community, this will also benefit the nation since we would have more doctors.

Increase the number of Diverse Health care providers

Pew research found that more than two-fifths of Latino patients considered the physician’s ability to speak Spanish important when selecting a doctor. Attention should be focused on the wide gap between the ethnic structure of the U.S. population and the structure of the healthcare workforce. The underrepresentation of Latino healthcare workers in health jobs must be addressed by creating diversity requirements for medical school accreditation, and fund grants to diversify healthcare development programs. There are specific matters that affect Latino’s desire to seek health care treatment. One of the low number of Latino healthcare providers. To increase the number of Latino doctors the United States Department of Health and Human Services (DHHS) should focus on making sure the healthcare workforce is diverse specially in the areas with a high percentage of latinos Latino representation must be at all levels of the decision-making process in health care administration decisions. This is crucial to respond to the changing health needs of Latinos in the country to make sure that those that the country has a healthy workforce and the future generations of our nation are healthy. If a patient and the doctor do not speak the same language (clearly) than there is a big chance that the patient will not understand the doctor’s description of the illness, and treatment advice and this lack of same-language health care services can have life-threatening consequences on the Latino community since it is likely that the patient will not finish receiving the adequate treatment due to not understanding the illness well. Given the diverse cultural backgrounds of Latinos, consideration should be given to cultural and language compatibility between the communities and healthcare providers. To get more Latinos to join the healthcare field we must remind them that good medical experts are valued extremely high in the United States. Jobs in healthcare guarantee great opportunities and job security. Some medical students join because they lost their loved ones to fatal diseases so they want to contribute to the medical field by finding a cure to the most complicated disorders. And finally, a career in healthcare provides an excellent opportunity to live and work in different parts of the world. As our population, has grown larger and older, our supply of trained doctors, nurses, and other professionals has not kept up with the increased demand. What is surprising is that none of the current healthcare proposals make any effort to deal with the supply of healthcare providers.

Operating Facilities

Healthcare services should be welcoming and accessible to Latinos and they should be in the areas that have a high percentage of Latino individuals and be close to their communities. Studies have found that Latinos who Spanish as their first langue have poorer experiences with health care than whites and Latinos who speak English. Close doctor-patient relationship is important for Latinos to feel that they are receiving the best possible care. I suggest healthcare providers partner with community health centers (CHC’s) located in Latino communities since they tend lack the resources and diverse staff needed to provide high-quality treatment These centers have the experience and knowledge needed to make a direct impact on their local communities. Creating operations in cities with high Latino population will increase the number of patients able to easily access healthcare facility. Latinos will choose to visit healthcare facilities if it satisfies their need for a Spanish-speaking staff that offers satisfactory services and support. Non latino Health care staff must receive cultural competency training for institutions serving the Latino communities. Providers should operate the centers to cater to the Latino needs which means that they need operating facilities that are accessible to Latinos, its necessary to employ multilingual nurses/doctors, health care facilities needs to have staff that is part of the community, and compose the Board of Directors of Latino leaders from the local community. This will make Latino patients feel that they are receiving outstanding healthcare treatment.

Increase Assistance Programs Advertising

Increasing awareness about health services offered is important to address Latino health disparities problems. I propose the following: to spread educational materials tailored to Latinos the federal, state, and local governments need to work with churches, media, and community groups that are sources of health information for Latinos. Most Latinos obtain information from media and per the Pew Research Center, 57 percent reported that the health information they gained from the media led them to visit the doctor. The healthcare system must adjust its services and marketing based on local Latino demographics. The best practice would be to design a community engagement process that will achieve long-term and viable outcomes and implementation at the district level.

Conclusion

Learning about how some Latinos have passed away due to being forced to avoid treatment due to lack of insurance and money to pay for treatment had a great influence on me. I believe that no one should die because of lack of money and health benefits. Thinking about everyone that passed away in pain without treatment is what motivated me to write about this specific topic.

My hope is that the reader understands that the Latino community will soon be the ethnic majority in the nation, they are the future of our workforce, and they have a great need for accessible and affordable health care. I discussed some steps that we can take to provide adequate healthcare services to the low-income Latino community. Addressing the shortage of Latino healthcare providers and the need for affordable health insurance will create a more diverse healthcare force, and they will be able to provide adequate health services for Latinos and others in the nation that will need it. Health care provider need to recognize that the Latino population is unique and diverse in its needs and that solving these disparities benefit the country. Now it’s time for our government and lawmakers to show compassion and take care of the communities that struggle to get health care. Health disparities are a result of language/cultural barriers and access to health care and that can easily be addressed with the right approach. The next step is for DHHS and lawmakers to put together a plan that is focused on providing health care coverages/services to areas with low percentages of health coverage and high percentage of Latinos. Addressing health disparities will not be solved all at once, so they need to continue to push for better healthcare coverage until everyone in the nation can access affordable and quality healthcare. It is a problem that needs to be evaluated and updated as new needs arise in the country.