Insurance and Care

The Effect of a Person’s Ability to Get the Care That They Need Due to Insurance

Acknowledgement

I acknowledge all those who contributed towards the successful completion of the project. Specifically, I thank my teachers for the commitment they have put this far. I also thank my colleagues who played fundamental functions in motivating me. Finally, I thank the librarian and all other stewards in all the resource centers that I visited in the course of completing the project for giving me an easy time.

Table of Contents

Abstract…………………………………………………………………………………4

Introduction……………………………………………………………………………..5

Background Information………………………………………………………………..6

Literature Review…………………………………………………….…………………8

Methodology……………………………………………………….……………………16

Research Questions……………………………………………………………………..16

Objectives……………………………………………………………………………….16

Research Design………………………………………………………………………..16

Data Collection………………………………………………………………………….18

Research Questions……………………………………………………………………..19

Data Analysis……………………………………………………………………………21

Results…………………………………………………………………………………..22

Limitations………………………………………………………………………………23

Discussion……………………………………………………………………….………23

Conclusion………………………………………………………………………………24

Works Cited……………………………………………………………………………..27

Appendices………………………………………………………………………………30

Abstract

The unfavorable terms and conditions of some health covers make it difficult for a considerable number of Americans to enjoy health cover. Evidence suggests that whereas high-income earners are less likely to encounter the challenges associated with securing health cover and benefitting from it, their low-income counterparts face a lot of challenges in their attempt to secure similar protection. Hence, there is need to look into the matter as effectively as possible to ensure that an individual’s socioeconomic status does not inhibit them from getting the appropriate protection they require. On the same note, the essay emphasizes the need to address the long waiting times associated with certain insurance providers that deter them from accessing preventive and urgent care. Structures already exist to determine the provision of health cover but more needs to happen to overcome the challenges that still deter accessibility.

The Effect of a Person’s Ability to Get the Care That They Need Due to Insurance

Introduction

The study will examine how a person’s ability to access care due to insurance impact on their health and well-being. It is apparent that across the country, individuals are influenced by the type of their health cover. Although many individuals across the U.S. have health cover, various factors impact on their choices thus making them not very beneficial to them. The analysis examines how various factors, including high deductibles and premiums impact on how people rely on insurance for paying for their health costs, as well as considers how other factors such as socioeconomic factors (Rice et al., 896), inappropriate plans, lack of knowledge and awareness, and patient/staff encounter with insurance determine how patients use the cover to mitigate costly bills and enjoy preventive care services that are considerably important. Indications suggest that ineffective healthcare plans lead to poor health outcomes, especially for low-income earners who lack the capacity to afford advanced forms. In addition, the study provides information to show how patients and staff’s experience with insurance influences how the coverage benefits their holders. Consequently, the exercise gathers data by engaging various patients and health practitioners within a clinical setting, particularly a neurosurgery station in a station for personalized health. The face-to-face engagement offers the chance to acquire relevant data about the issue under investigation while getting to know the respondents’ attitude towards the matter. The results section confirm that many people have unpleasant encounters with their health cover plans that deter them from accessing the needed care. Consequently, there is need to address the concerns to achieve a situation where as many Americans as possible enjoy the protection that they receive from their plans rather than having to face much constraint introduced by their plans.

Background Information

In 2010, just before the U.S. implemented vital components of the ACA, approximately 18% of its inhabitants not more than 65 years did not have health cover. In the U.S., considerable unhealthy lifestyles and gaps in health insurance add onto effects that usually compare inappropriately with those monitored in other high-income nations. Within the first few months of 2014, the ACA had considerably altered health insurance in the U.S. but most of its components such as formation of accountable care institutions, Medicaid expansion, health cover exchanges, and adequate oversight of insurance firms – still encounter considerable challenges (Kearney). Thus, concerns still exist that many adults in the U.S. still have challenges affording various types of health services and dental costs. In addition, the challenge extends to the high cost of health care that usually inhibit people from accessing required prescriptions or care.  Kearney expounds on this matter by stating that approximately half of adults in the U.S. accept that they disregarded or avoided some form of health care in the past year because of the high cost associated with the cover. Besides, three out of ten, which gives a representation of 29% also accept not taking their medicines as recommended at particular points in the past year because of the high cost. Evidence further suggest that high health care costs and the unclear insurance policies disproportionately impact Hispanic and Black adults who are not insured, and those whose income is not stable. It happens that significant shares of adults in the U.S. in each of these ethical groups show considerable hardship affording different kinds of care and postponing or delaying medical care as a result of the high cost.

Nonetheless, that does not imply that those who are under health cover are protected from the burden associated with health care costs. Approximately 46% of adults with insurance report hardship achieving their out-of-pocket costs, and about 1 in 4, which is about 27% encounter hardships meeting their deductible (Kearney). With these challenges, it becomes apparent that paying medical bills can have substantial effects for the American families. For instance, in the third March of 2019, nearly one-fourth of adults in the U.S. or about 26% indicated that they or a member of their family have had challenges settling medical bills in the past one year, while nearly about half of the group or 12% of all American adults reported that the bills had a substantial influence on their family (Kearney). Issues affecting medical bills also disproportionately cause challenge in families where they or an affiliate of the family has a devastating serious health complications.

Moreover, the cost of health care top the list of expenditures that people find it hard to afford. Considerable shares of adults in America experience hardship paying for different components of health care encompassing almost half who accept having constraints financing dental cover or about 46% and almost a similar portion of adults with insurance who accept that they encounter considerable challenges affording out-of-pocket costs not included by their health cover (Kearney). The shares are considerably higher than the rates of those who accept that they encounter hardships meeting other household financial requirements such as groceries, food, monthly bills, gasoline, mortgage or rent. Other than these costs, about one-quarter of those assessed accept that they experience considerable constraints remitting payment for vision or hearing care (33%), while another 27% (one-quarter) admit that the premium that they pay on monthly basis is not easy to meet (Kearney). Those with considerably lower income levels, including Hispanic and Black adults are more likely to encounter hardships meeting some medical requirements. Meeting vision, dental, and hearing care is also a challenge among adults aged 65 and above and those gains are not largely protected by Medicare.

Chart 1 that appears in the appendix section provides a breakdown of adults in the U.S. who accept that it is not easy to meet the costs of out-of-pocket health care costs among other key services. It shows that those who cannot meet out-of-pocket costs for medical care not protected by their insurance and for dental care top the list with 46% not being able to meet the obligation (Kearney). It is followed by those who are unable to meet the payment for vision or hearing care, encompassing office visits, eyeglasses, or hearing equipment and those who are unable to meet their mortgage or rent at both 33% (Kearney). The third in the rank are those who are unable to meet the costs of gasoline of other costs associated with transport or gasoline and those who are not able to meet the costs of heat and electricity at 30%. Following in the rank are those who are unable to meet their monthly obligations for health cover, prescription drugs, and food at 27%, 26%, and 25%, respectively (Kearney). However, the following sections provide a thorough analysis that helps to understand the factors that make it difficult for some people to meet the costs associated with their insurance.

Literature Review

This literature review examines how a person’s ability impacts their access to insurance to get the care that they need. The distribution of health services is significantly influenced by socioeconomic factors. Health insurance ensures that these services are affordable and equitably distributed across the population. Most patients face many challenges in accessing high-quality care due to high deductibles. Although both public and private health insurance initiatives aim to increase healthcare quality and accessibility, most patients grapple with high deductibles, copayments, delays in surgeries, and poor insurance health literacy.

Delay and Avoidance Preventive Care

Patients face many barriers in their insurance coverage to access preventive care. Despite healthcare reforms in the US, including the enactment of the Affordable Care Act, more than 30 million Americans lack health insurance (Sommers 2395). The low access to insurance contributes to poorer health outcomes. A person must have a valid insurance plan before they can access any preventive services. Additionally, many Americans are unaware of their coverage options. For instance, the ACA offers expanded access for preventive services without the option of cost-sharing. Smith et al. note that individuals who are unaware of the complete coverage for preventive care may delay or avoid seeking health services until their illness is severe and requires advanced medical care (2). The delays have adverse long-term effects on a person’s health and may lead to costly procedures in the future. Although all insured persons qualify for preventive care regardless of their insurance option, delays in seeking care contributes to poorer health standards among the American population.

Health insurance literacy influences the uptake of preventive care among patients. A study by Tipirneni et al. established a correlation between insurance literacy and a delay in accessing preventive care (1). Most Americans have foregone care because of their poor understanding of insurance costs. The levels of health insurance literacy vary across diverse demographic groups. Another study by Smith et al. highlights that individuals with low health insurance policy are likely to delay or avoid preventive care due to cost (2). The failure to make informed decisions affects the quality of care and uptake of medical insurance plans. Although most Americans are worried about the cost-implications of many medical procedures, they do not understand the coverage of their insurance. Besides, interruptions in insurance coverage limit the general access and preventive care among patients. Reforms in the sector should focus on improving health insurance literacy across different demographic groups to increase the demand for preventive services among insured individuals.

Simon et al. states that the U.S. population receives suboptimal levels of preventive care despite expansions in insurance coverage (1). One of the goals of insurance schemes, including Medicaid, was to increase preventive care by expanding access to health insurance. Most people are likely to avoid routine hospital visits unless they are sick to reduce the high cost implications of the process. The ACA mandates health insurance plans to cover a patient’s preventive services without cost-sharing (Simon et al. 2). However, the expansions in health insurance coverage have not achieved the expected results. The uptake of preventive care is slow among adults in the country despite the reduction in the out-of-pocket costs. The study established that many adults do not use preventive services even in its free plan. The long wait times at provider offices may discourage the demand for preventive services. Therefore, the demand for preventive services to insurance providers is low despite expansions in their coverage.

Ineffective Insurance: Lousy and Poor Plans

The design and terms of some insurance plans contribute to underinsurance and high out-of-pocket costs. While employee-based medical insurance is prevalent, millions of Americans cannot afford the appropriate plans based on their health status and income. According to Dey and Bach, more than half of the population spent $276 for healthcare in 2016 (1242). Given that the US has one of the highest costs of medical care, most patients are underinsured. These patients are unlikely to receive the care they desire or need due to high cost implications. Conversely, the top 5% of the population has access to more than $50,000 for their medical care. (Dey and Bach 1242). While this demographic can afford private insurance and the out-of-pocket costs, they are covered adequately by their plans. Most treatment options are not included in these low premium options. Despite the reforms implemented by the ACA, most Americans enroll into poorly designed insurance plans due to their lower-income status.

Insurers use different terms to limit access to medical care to clients. While many patients may have insurance, they may be required to pay for many of the services. The low premium but high deductibles plans adversely affect access to care. A study by Smith et al. established that many people avoid seeking medical care due to the high deductibles associated with their plans (2). An effective insurance plan should correspond to the patient’s income, education, age, gender, and ethnicity. Groups that face historical disparities require wider coverage as compared to the white majority. However, a general plan for all consumers fails to address institutional barriers to care. Consequently, most patients have to wait for lengthy pre-approval periods before their treatment is approved. They may be denied critical procedures, including surgeries too. Insurance companies should attempt to offer favorable terms to their customers to improve access to care in the US.

High Deductibles in Insurance Plans

The patient’s ability to pay for insurance impacts access for care. Insurance plans use different pricing strategies to attract consumers. Loewenstein et al. notes that most “consumer-driven” health insurance plans popular among employers and insurers incorporate high deductibles that apply to most services (856). However, insured persons face challenges in determining the most appropriate plans. While some plans are lowly priced, they involve the payment of high deductibles. High deductibles associated with healthcare utilization may discourage insured persons from seeking care even though they do not apply to preventive services (Smith et al. 2). Decision errors in selecting the most appropriate plan forces many consumers to take unfairly priced packages. Lowly priced plans may involve high deductibles, leading to high avoidance and delays in seeking medical care.

High deductibles limit the efficacy of health insurance despite the increased access and coverage by insurance programs. Although many Americans have access to health insurance, they face several financial barriers. One study indicates that more than 30% of lower-income adults in the US encounter such financial barriers to care. Cost sharing initiatives, including cost sharing and copayments, increase the costs of treatment even though the individuals are insured. Davis and Ballreich note that the many insured adults in the US avoid getting the recommended treatment due to huge costs (1568). Patients may be required to pay additional money for their procedures even if they are insured. The authors argue that the American system relies heavily on patient cost sharing, including higher deductibles. Most people facing financial difficulties are forced to forgo care or seek loans to access care. Therefore, high insurance deductibles limit access to care among insured persons.

Underinsurance exposes insured people with medical coverage to financial risk. A study by Lavarreda et al. indicates that while most people are insured, many costs are still passed onto the consumer (472). The authors indicate that individuals who are underinsured face similar barriers to care compared to those who are completely uninsured. Most insured persons from lower-income households face a substantial risk of out-of-pocket medical costs. Many private insurance schemes allow individuals to take high-deductible plans, which exacerbate the problem of underinsurance. A person’s socioeconomic status impacts their access to care. Minority groups face more barriers due to income disparities, low access to generational wealth, and unequal distribution of resources. Groups that traditionally face discrimination in their access to care also face underinsurance challenges. Most patients may be forced to forgo routine and specialized treatment because it increases their out-of-pocket expenditure. Overall, underinsured patients face financial barriers to care and may avoid preventive and other medications to save on costs.

Variances in insurance spending disproportionately affects poorer households. Although all groups of people purchase health insurance, the benefits they gain are so different. High income families have better access to health and insurance coverage than their medium and low income counterparts. According to Dey and Bach, the top 5% health spenders in the US accounted for 50% of the total spending, an average of $50,000 per person, whereas the bottom half of the population only spent $276 per person in 2016 (1242). The broad access for small usage fees approach is ineffective and discriminatory against most of the country’s population. Income disparities contribute to the variances in insurance spending on different demographical groups. With the high costs of healthcare in the country, most citizens lack adequate access to medical insurance. Hence, insurance spending disproportionately affects low-income subscribers.

Surgery Delays Due to Insurance

Prior authorization by the insurer forces patients to wait for medical care. According to Miller et al., prior authorization takes time from direct patient care and increases the cost of delivery of care (1937). Physicians delay their services as they wait for pre-approval by the insurer. The patient is forced to delay their surgery even though the doctors have already recommended immediate intervention. The article indicates that some patients abandon the prescribed treatment due to the lengthy approval process (Miller et al. 1937). This lowers the quality of care as individuals are forced to make numerous trips to the hospital for treatment. The approval process may take a day or several days before it is approved. In some cases, the patients may be denied surgical treatment even after waiting for the pre-approval period. The quality of medical care is undermined by the payer’s approval. Consequently, patients delay their surgeries as they wait for the prior authorization of the insurer.

Poor insurance coverage is associated with delayed surgical treatment in the US. Strohl et al. states that the type of a patient’s insurance cover influences the length of delay after diagnosis to treatment (511). Many patients experience adverse health outcomes due to delayed surgery after diagnosis. For example, women with Medicaid were 43% more likely to experience delays longer than six weeks (Strohl et al. 512). The period is longer for women without insurance and from minority groups. A person’s racial background and income levels impact their access to insurance. The health disparities that exist within a community are extrapolated to their access to surgery. Although the underlying goal of insurance is to foster the equitable distribution of care, it propagates the existing disparities among populations. Individuals that can hardly afford insurance and those with high deductibles are forced to delay their surgeries due to the cost implications and prior authorization by the insurer.

Surgical delays vary depending on the insurance type. A study by Adamson et al. established that differences in insurance coverage influence the length of delays among cancer patients (1106). In the US, Medicaid patients experienced the most surgical delays. The patients may be forced to delay their surgeries for more than six weeks (Adamson et al. 1106). While the approval process is quicker in private insurances, the challenge is prevalent across all sectors. The surgical delay varies across different demographics. Patients from minority groups are more likely to experience more and lengthier delays as compared to the white patients (Adamson et al. 1106). Although this article focuses on cancer patients, the rates of surgical delays are consistent across different ailments. Reforms in the public-mandated insurance will assist patients attain medical care without undue delays.

Patient/Staff Experience with Insurance

Insurance coverage is linked to higher patient satisfaction. Insurance reduces the out-of-pocket costs associated with medical care and increases accessibility to high-quality care. A study by Fenton et al. associates high patient satisfaction with insurance coverage when other factors, including age, gender, race are adjusted (407). The levels of health satisfaction vary across uninsured, privately insured, and publicly insured. The aspects of patient satisfaction are integral in determining whether they are content with their coverage and the quality of services. For instance, patients who experienced delays in surgeries are unlikely to be satisfied with their insurance provider. Additionally, high deductibles and out-of-pocket costs adversely affect the experiences of patients with their insurer. Most people may be forced to delay or avoid treatment options because they cannot afford the co-payments and additional costs. A person’s social, economic, and racial identity impact the experiences of groups. Therefore, the extent of insurance coverage influences their experiences and satisfaction with health services.

The contemporary health insurance regime positively correlates with the experiences of health professionals. Health insurance, including Medicaid, use value-based payment systems that reward healthcare professionals for their efficiency and quality of services (Obama 528). Private healthcare providers use insurance to meet the health needs of their patients. However, the system of billing may influence how they perceive a specific insurer. For example, some insurers take an inordinately long time to approve the treatment options for the patients. This increases the workload for the physicians while exacerbating the illnesses of patients. Nevertheless, the expanded access to insurance coverage positively benefits the entire American health system. The free preventive care option enhances community health while reducing future hospitalizations among the population. Although the inefficiencies of prior authorization may delay critical treatment, health practitioners are satisfied with the role insurance plays in improving the quality of care in the country.

Methodology

Research Questions

  • What are the effects of one’s ability to access health insurance on their ability to access quality care?
  • What are the effects of high cost of insurance on accessing care, particularly for low-income earners?
  • Are there potential ways to address the problems?

Objectives

  • To find out whether lack of health cover could impact on one’s ability to access quality care.
  • To identify how high deductibles, premiums, and out-of-pockets impact one low-income individuals to access health care.
  • To know the views of health practitioners regarding the constraints surrounding their patients’ access to health cover.
  • To identify potential approaches to dealing with the problem

Research Design

The study takes place within a clinical setting, particularly in a neurosurgery office in a facility for personalized care. The setting is suitable for this study because it is possible to meet different people seeking services, thus making it simpler to engage them about the issues that they encounter when it comes for paying for their insurance and how this impact on their receiving of care. In addition, the facility is appropriate because the researcher does not have to go about looking for participants to partake in the research process. Instead, they come by themselves and what the researcher does in this case is only to identify those who are better placed to partake in the exercise. In addition, the environment is suitable because it is likely to offer an environment that is conducive for conducting the research. Specifically, conducting the study at the facility provides a condition that is free from noise or disruptions that could likely occur when the practice takes place in other contexts such as in the open where various movements and sounds could easily interfere with the undertaking.

Overall, 20 participants take part in the study. They comprise of both males and females (15 males and 5 females). Out of the 20 participants, 13 are patients who come at the facility seeking for various services while the remaining 7 are health practitioners who engage the patients on regular basis, including those who find out whether a patient has a suitable health plan and could therefore receive services at the facility. It is necessary to engage both patients and practitioners in the exercise to gather diversified views regarding the issues affecting insurance holders, both from the perspective of the patients and caregivers who are equally conversant with the challenges that adult patients meet when it comes to financing their health cover. Overall, the average age of those who partake in the exercise is 40 years. The practice brings together participants from different backgrounds and affiliations without considering their races, religion, sexuality, educational background, political affiliation, tribe, or social class. The practice ensures that it brings everyone on board to achieve a scenario where no one is secluded from the exercise in an attempt to get everyone along. The other inclusion factors considered during the selection process are those who have a health cover regardless of the type. However, the exercise excludes those who lack health cover, are non-Americans, or are not 35 years and above.

Data Collection

The collection of data in the process happens by engaging those who partake in the exercise. Using face-to-face interviews provides a suitable chance to acquire information that helps to understand some of the challenges that they meet servicing their health cover. Specifically, the data collectors deploys face-to-face interviews because of the various merits associated with the process. For instance, using the technique presents an opportunity to regulate interactions and to make sure that they targeted participants are the respondents (Curasi; Saarijarvi and Bratt 3). Besides, using the approach to gather data permits the researcher to ask much detailed questions and to acquire in-depth information about behavior and attitudes concerning the issue under investigation. Specifically, the exercise uses open-ended questionnaires because of the gains associated with this approach as opposed to closed-ended questionnaires. Some of the reasons why the exercise relies on open-ended questionnaires is that the approach provides richer awareness acquired from personal engagements (Hyman and Sierra 3). If a researcher utilizes open-ended questionnaires, there is enhanced likelihood for participants to share their perceptions and point of view. Using open-ended questionnaires also give the chance to probe into a matter further, especially when the data collector is interested in learning more about a particular issue. Furthermore, open-ended questionnaires are preferable in this instance because it offers the chance to acquire information about a participant’s demographic information as well as increases the chances for improved satisfaction on the parts of the participants (Hyman and Sierra 3). However, that does not imply that the data collection technique does not have potential limitations. One of the possible constraints associated with the technique is that it could be time-consuming, especially when the data collector seeks to inquire about many things (Hyman and Sierra 4). The process is likely to take much time because each participant takes their time to address the various issues. The other challenge witnessed when using the open-ended form is that it is possible to acquire information that is not relevant, an issue that may lengthen the time of study because the researcher must analyze each of the collected data. Nonetheless, the approach of collecting data is still favorable for this analysis because the merits appear to overcome the demerits.

Research Questions

The research questions for this study falls under two categories. The first targets the patients who seek various services at the facility while the other targets caregivers who engage with patients and therefore understand the challenges that they encounter presenting or financing their health plans. Garnering data from both provides a holistic view of the whole issue, and provides the researcher with an opportunity to make informed decision on the matter. The following are the questions targeted towards both the patients seeking various services and the healthcare providers who understand the challenges that patients encounter in their attempt to rely on their health cover;

Questions targeted towards patients

  1. What challenges contribute towards the delays you experience and the factors that lead to avoidance of preventive care?
  2. Have you had any experiences with effective or lousy and poor insurance plans?
  3. Do you encounter any complications with deductibles in insurance plans?
  4. Have you been a victim of surgery delays as a result of insurance?
  5. What do you think should happen to address the issue?
  6. Do you think that one’s socioeconomic status contribute towards their getting of health cover and relevant services?

Questions targeted towards health practitioners

  1. Do your patients present issues touching on their health plans?
  2. What are the key concerns that you feel most patients present touching on their insurance?
  3. Do you think that high-income earners have a better chance for securing health insurance that guarantees them quality care as opposed to those with low income?
  4. What are some of the mitigating measures that would help to address the problem more effectively?

The researcher identifies the patients who take part in the exercise using stratified random sampling, which entails keen analysis of those who take part in the exercise to settle on the right participants who are likely to give the needed information. The technique entails the separation of a population into smaller sub-divisions called strata, which the researcher forms depending on the members’ share features such as educational level and income (Mostafa and Ahmad 1). The approach also known as proportional random sampling is suitable for this study because it permits the one steering the process to acquire a sample population that effectively represents the whole population being examined. The approach is different from simple random sampling, which merely entails the random choosing of data from a larger population, so each probable sample is equally likely to happen (Mostafa and Ahmad 1). However, in simple random sampling, the chances of settling on a group that is more likely to give the appropriate response regarding the matter under investigation is minimum because the selected team may lack the necessary information. Besides, using the simple random approach increases the probability of experiencing bias that could emerge when the sample is not representative of all groups as effectively as possible to represent the whole population (Sayed and Ibrahim 295). However, with stratified sampling, the researcher has a chance to select a sample that he/she thinks is appropriate enough for the research.

In the process of gathering the relevant data, the researcher begins by seeking consent from an identified participant by asking them if they are ready to take part in the exercise. The values of informed consent with concern to research on human participants can be viewed with regard for participants, engaging them with the research and improving the researcher-participant affiliation, which may lessen possible litigations and dissatisfaction. It is after getting the permission that the researcher engages the participants in the series of the identified questions while giving them time to respond to each question as much as they want to acquire more information regarding the issue under investigation.

Data Analysis

The applicable data analysis process for this study was the descriptive approach. The technique according to Hussain entails describing, summarizing, or showing data sets in a constructive manner such that it is possible to identify patterns that fulfil particular aspects of the data (Yellapu 61). The approach is one of the most crucial phases of performing a data analysis (Hussain 742). Using this data analysis technique presents an opportunity to identify some of the main themes that emerge from the response such as hardships in financing health plans, poor health plans, and longer waiting hours, which makes it possible to know the issues that deter some people from enjoying the benefits of having health insurance. However, the primary limitation associated with the approach is that it is possible to encounter high level of biasness.

Results

Overall analysis of the collected data affirm that a considerable number of Americans still encounter considerable challenges in benefiting from health cover. Out of the 13 patients who take part in the exercise, about 8 participants (62%) confirm that they experience considerable challenges with their health cover. Among those who claim that they encounter serious issues with their health cover report that the deductibles that they pay before their insurance comes in are considerably high, particularly for those seeking cover from private institutions. In addition, some of those who find fault with the insurance system blame the high premium rates that deter some people from keeping their plans and opting out altogether. The other five to add up to the 13 insinuated that whereas they service their health cover as provided for in law and in the terms and conditions of the plans that they follow, they still encounter considerable challenges that affect how they get health services. Three of the remaining five accept that even with the health cover, they sometimes have to wait for longer hours, which could be dangerous in scenarios where they seek for quick intervention. Among the three who state that they remit their payments in time, one has been late for surgery because the insurer took unnecessarily long to confirm their status before giving the go ahead to proceed with the intervention. The seven practitioners who take part in the exercise give similar sentiments. All the seven health workers confirm that they have all witnessed scenarios where patients lack necessary services because of the issues affecting their health insurance. According to three of the seven health workers, they have had to withhold services on patients for lacking health cover, and the other four stating that a considerable number of their patients complain about the challenges that they face when it comes to relying on insurance. Two of the participating practitioners confirmed that they have had to withhold surgery services on patients who needed it urgently because of having issues with their health cover.

Limitations

Whereas the study has various strong elements, it is possible to identify certain constraints in the exercise. One of the evident limitations is that the number of participants in the exercise is significantly low, which restricts the chances of gathering a more holistic and comprehensive dataset. Engaging a small number of respondents is challenging because this may result in the collection of information that does not give a dependable view of the larger society. Thus, those who will perform a similar study in future should consider increasing the number of participants to enhance the likelihood for generating data that is dependable and reliable. The other limitation associated with the analysis is the timeframe allocated to completing the entire exercise. Specifically, the whole process lasts only four days. The first and second days are dedicated for identifying and interviewing participants, the third day is committed to analyzing the collected information, and the fourth and final day involve reporting the collected data. However, the research still continued regardless of the limitations.

Discussion

The analysis reveals one major thing – that despite the existence of regulations that advocate for effective and widespread provision of health insurance, the guidelines do not seem to be adequate of effective because many people still lack this essential protection. Unfortunately, a significant number of those who are under cover still encounter numerous hardships receiving health care due to various reasons. So far, as it appears in Chart 2 in the appendix, a larger number of Americans (51%) are insured by their employers followed by those who are protected by Medicare and Medicaid who both take 17% (Young and Fiedler). About 5% of Americans acquire their protection from individual markets while another 9% lack insurance (Young and Fiedler). Whereas the data reveals that a large number of Americans already have cover that does not reflect the condition on the ground where the cover does not seem to be of much help to most people who still encounter considerable challenges accessing care. The study confirms that many people who are protected still have to wait for longer hours or even days before their service providers confirm that they should receive attention. The loopholes suggests the need to review existing structures to ensure that such hurdles do not exist and that people get the necessary services that they require, especially if they validly own an a health cover plan (Young and Fiedler). The failures encourage the various groups responsible for providing the cover to be keener in their terms and conditions to ensure that owners do not encounter the many issues that deny them the chance to benefit and develop better health.

Conclusion

The study presents information that helps to understand some of the factors that deter some people from enjoying the benefits of health cover. It emerges that whereas those with high income have the ability to pay for health insurance that allow them to access high quality services, that is not the situation with low-income individuals who can hardly afford plans that guarantee them appropriate care. Those with low income can hardly afford to pay deductibles, premiums, and out-of-pocket fees that appear to be considerably high. Consequently, many of those who encounter considerable challenges in this area end up getting services that can hardly address their health concerns. In addition, challenges emerge because of the inefficiencies associated with particular health plans. The analysis reveals that sometimes, patients have to wait for a long time before their insurer process their request. The delays deter them from accessing care, a situation that could have fatal outcomes in scenarios where the needed care is urgent such as in the case of an emergency. The analysis includes a qualitative research that gathers data through interviewing patients and health workers who understand how the insurance system works. The collected information reaffirms that not every patient have the same experience when it comes to relying on health insurance to cover for their bills. It emerges that the majority of those who encounter considerable challenges are those who cannot afford costlier plans and those who find it hard to put up with the payments one has to pay before their insurance cover for all the health services that they receive. Unfortunately, such kind of indiscrimination when it comes to relying on health insurance could deter the goals of the government in offering affordable health services to everyone without looking at factors that make people different. Hence, there is need to consider some of the factors that would foster significant improvement in this area. An appropriate approach would be to review existing policies to ensure that those charged with providing cover adhere to the provisions. In this regard, it is essential to reexamine the directives of the ACA that has the potential to improve coverage across the country. The developers and implementers of the legislation should critically evaluate it to identify and rectify elements that that still deny some people the chance to access health cover because of some unclear or inappropriate terms. Furthermore, those responsible with implementing existing policies impacting on issuing health cover should identify the terms that still deter low-income earners from adequately paying for their program because of the high costs. It is necessary to replace them with friendlier terms to evade scenarios where some people have health cover but cannot benefit from them due to the surrounding difficult circumstances. Thus, embarking on overturning the status quo would improve how people access health services, which will impact on their well-being and ability to perform their duties. The engagement should take into account that not every person still has the capacity to finance their health cover despite the attempts to enact changes in existing policies. It is also essential to take into account that whereas some individuals encounter considerable constraints with the coverage, others enjoy the services and also get huge income that would suffice even if they pay cash for the services. Hence, the discrepancy calls for quick intervention to salvage the situation that could easily get out had if nothing happens. Otherwise, disregarding the matter may worsen the health condition of many Americans whereas good health is a critical determining factor for building a productive nation.

Works Cited

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Appendices

Chart 1 – Adults in the U.S. who find it difficult to afford out-of-pocket health costs

Source – Kearney

Chart 2 – Percentage of people under different insurance plans

LinkeYoung-ENG-Pie-(LB)_2-01

Source – Young and Fiedler

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