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NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue

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    NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue

    Student Name

    Capella University

    NHS-FPX 6008 Economics and Decision Making in Health Care

    Professor Name

    Date

    Addressing a Local Healthcare Economic Challenge

    The issue of healthcare accessibility and the availability of sufficient health insurance coverage is a paramount concern for individuals, healthcare providers, and healthcare organizations alike. A crucial economic challenge lies in insufficient health insurance coverage, impacting the ability of individuals to receive timely and quality healthcare services (World Health Organization, 2019). This report delves into the economic implications of inadequate health insurance coverage and its repercussions on healthcare delivery.

    Causes of Insufficient Healthcare Insurance

    The challenge of inadequate health insurance coverage has persisted in the healthcare industry for numerous years, affecting the entire healthcare system from patients to healthcare providers and organizations. In 2019, the Centers for Disease Control and Prevention (CDC) reported that 28.9 million individuals in the United States lacked health insurance, a number likely exacerbated by the COVID-19 pandemic (Centers for Disease Control and Prevention, 2021).

    Description of Insufficient Health Insurance Coverage

    One particularly vulnerable community grappling with this issue is comprised of low-income individuals and families. San Francisco General Hospital (SFGH) plays a crucial role in catering to uninsured and underinsured patients (San Francisco Department of Public Health, 2021). According to a report by the San Francisco Department of Public Health, in 2019, 10% of San Francisco residents lacked health insurance coverage, with an additional 9% reporting difficulties accessing care despite having coverage (San Francisco Department of Public Health, 2021). This demographic is prone to delaying or forgoing essential medical care due to financial constraints, leading to adverse health outcomes.

    Impacts of Insufficient Health Insurance Coverage

    The repercussions of inadequate health insurance coverage are evident at San Francisco General Hospital (SFGH), where a majority of patients are either uninsured or covered by Medicaid. This situation poses challenges in accessing care and strains the hospital’s financial resources due to uncompensated care. To counteract this, SFGH has implemented various programs like financial counseling services and a charity care program for eligible patients (San Francisco Department of Public Health, 2021).

    Justification for Healthcare Insurance

    The rationale behind inadequate healthcare insurance coverage is deeply rooted in the fundamental principle that access to quality healthcare is a basic human right. Unrestricted access to necessary medical care is essential for maintaining good health and well-being, and any hindrance can lead to exacerbated health outcomes and financial hardships (Cohen et al., 2020).

    In the United States, several factors contribute to the issue of inadequate healthcare insurance coverage, including the exorbitant cost of healthcare services, the intricacies of the insurance system, and the scarcity of affordable insurance options (Cohen et al., 2020).

    Motivation for Selecting Healthcare Insurance

    My choice of this issue is influenced by personal experiences as a healthcare provider and a community member affected by inadequate healthcare insurance coverage. Having witnessed the detrimental effects on patients’ ability to access necessary medical care and the financial strain on healthcare organizations, I advocate for addressing the issue. As a member of the affected community, I acknowledge the barriers individuals and families face in accessing care due to financial constraints and assert that access to quality healthcare is a basic human right that should not result in financial hardship.

    Significant Impacts of Healthcare Insurance on Diverse Groups

    Inadequate healthcare insurance coverage significantly impacts my role as a healthcare provider, my organization, my colleagues, and my community, disproportionately affecting diverse and lower socio-economic groups, exacerbating health disparities (Tolbert et al., 2020).

    For healthcare providers, insufficient insurance coverage adversely affects the quality of care for patients. Patients from diverse or lower socio-economic groups are particularly susceptible to negative effects due to social determinants of health, such as poverty and limited access to healthy food options (Phuong et al., 2022).

    The impact extends to the organization and colleagues, leading to potential financial strain due to uncompensated care. This strain can affect the organization’s ability to provide quality care and invest in new technologies or infrastructure, resulting in workforce challenges like understaffing or staff burnout (Camilleri & Diebold, 2019).

    In the community, inadequate healthcare insurance coverage significantly affects diverse and lower socio-economic groups, with higher uninsured rates among people of color and those with lower incomes, as reported by the Kaiser Family Foundation (Kaiser Family Foundation, 2020).

    Contributing Gap to Inadequate Healthcare Insurance

    The gap contributing to inadequate healthcare insurance coverage arises from the absence of comprehensive and affordable health insurance options, especially for individuals from diverse or lower socio-economic groups. This gap is fueled by high healthcare costs, limited employer-sponsored coverage, and restrictive eligibility criteria for public insurance programs. Additionally, political challenges to the Affordable Care Act have created uncertainty about future healthcare coverage and access, necessitating the addressing of these coverage gaps to promote health equity and improve health outcomes for all individuals (Kaiser Family Foundation, 2020; Odeny, 2021).

    Policy Solutions

    Addressing this gap requires comprehensive policy solutions aimed at improving access to affordable and comprehensive health insurance coverage for all individuals, regardless of race, income, or pre-existing health conditions (Odeny, 2021). Potential measures may include expanding Medicaid eligibility, strengthening the ACA marketplace, and implementing policies to address the underlying social determinants of health contributing to health disparities and insurance coverage gaps.

    Supporting Evidence for Policy Solutions

    Evidence supports the notion that policy solutions to enhance access to health insurance can significantly impact health outcomes and financial stability for individuals and healthcare organizations. For instance, a study on Medicaid expansion in Michigan revealed associations with increased access to care, improved health outcomes, and reduced financial strain for individuals and healthcare providers (McInerney et al., 2020).

    Conclusion

    Inadequate healthcare insurance coverage stands as a critical economic challenge affecting individuals, healthcare organizations, and communities, particularly those from diverse or lower socio-economic groups. High healthcare costs and restrictive eligibility criteria for public insurance programs contribute to coverage gaps, resulting in poor health outcomes and financial burdens for individuals and healthcare organizations.

    References

    Camilleri, S., & Diebold, J. (2019). Hospital uncompensated care and patient experience: An instrumental variable approach. Health services research, 54(3), 603–612. https://doi.org/10.1111/1475-6773.13111

    Centers for Disease Control and Prevention (CDC). (2021). Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2019. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202102-508.pdf

    Cohen, S., Cohen, N., & Gabbay, E. (2020). Paternalism and certitude. Bioethics, 34(5), 478-482. https://doi.org/10.1111/bioe.12700

    NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue

    Kaiser Family Foundation. (2020). Key facts about the uninsured population. Kff.org. https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

    McInerney, M., Winecoff, R., Ayyagari, P., Simon, K., & Bundorf, M. K. (2020). ACA medicaid expansion associated with increased medicaid participation and improved health among near-elderly: Evidence from the health and retirement study. INQUIRY: The Journal of health care organization, provision, and financing, 57, 004695802093522. https://doi.org/10.1177/0046958020935229

    Odeny, B. (2021). Closing the health equity gap: A role for implementation science? PLOS Medicine, 18(9), e1003762. https://doi.org/10.1371/journal.pmed.1003762

    Phuong, J., Riches, N. O., Madlock‐Brown, C., Duran, D., Calzoni, L., Espinoza, J. C., Datta, G., Kavuluru, R., Weiskopf, N. G., Ward‐Caviness, C. K., & Lin, A. Y. (2022). Social determinants of health factors for gene–environment COVID‐19 Research: Challenges and opportunities. Advanced genetics, 3(2), 2100056. https://doi.org/10.1002/ggn2.202100056

    San Francisco Department of Public Health. (2022). San Francisco Health Plan 2022 Quality improvement program description & work plan. Sfhp.org. https://www.sfhp.org/wp-content/files/providers/QIEval/QIPlan.pdf

    NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue

    Tolbert, J., Orgera, K., & Damico, A. (2020, December 19). Key facts about the uninsured population. Kaiser Family Foundation. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

    World Health Organization. (2019, July 16). Universal health coverage. Who.int. https://www.who.int/health-topics/universal-health-coverage#tab=tab_