As a practicing Registered Nurse, I take enormous pride in my responsibility to provide the highest level of care to each and every patient I treat. I am obligated by the standards of practice to deliver skillful, compassionate and unbiased care with the goal of improving health related outcomes. In the vast majority of cases, I witness an appreciable difference in the quality of my patient??™s health status by the time they are discharged from my care. But for many of my patients, my concern then becomes what will happen to them after they are discharged because of the health care access barriers they may face. A number of issues affect a patient??™s access to healthcare.
What is the financial status of the patient Do they have adequate insurance Are they male or female Where do they live What race are they What is their ethnic background All of these issues can contribute to health care access barriers (Fiscella, 2011). These barriers can have far reaching consequences. Even though the United States spends more money per person on healthcare than any other industrialized country (Moorhead & Slavik Cowen, 2011), many Americans do not receive the care they need mainly because of health care access barriers.
Patients suffer preventable pain, illness and death-as well as more expensive care (Gauthier & Serber, 2005). In addition, patients may experience trouble in their family life, loss of employment and bankruptcy. But in many cases, the affects of inadequate access go beyond individual health consequences. Infection rates increase, public health and safety are adversely affected, crime and homelessness increase, and social agencies become overburdened.
Health care rates and insurance premiums increase. Employers drop benefits for workers or purchase policies so substandard that even their insured employees cannot afford necessary care. So because of these barriers, healthcare has become inaccessible to many Americans. Truly ??? accessible??? health care means care must be available, appropriate and affordable. When care is available, people receive the care they need in a timely manner. Medical care is offered within a reasonable distance from where patients live. The new emergence of nurse-managed clinics with nurse practitioners providing primary care may help make health care more available for people who are unable to access more traditional methods to manage their health care (Moorhead & Slavik Cowen, 2011). If patients have trouble leaving their homes, medical care should come to them.
This is an issue I see often in my practice. Many patients I discharge are basically home bound and have limited resources. To address this, there are primary care physicians who routinely do house calls and home care is regularly arranged for patients with these barriers. In addition, patients are able to receive early treatment for acute conditions. Preventive care is utilized more often. And patients with chronic diseases such as asthma, heart disease, diabetes, chronic obstructive pulmonary disease, and hypertension receive the proper treatment proven to help them manage their conditions more effectively so they have optimal outcomes (Stakowski, 2004). When care is appropriate, health care professionals collaborate to provide the patient with the care that is best suited for them. Cultural and linguistic barriers are addressed so the patients receive the proper treatment and can communicate effectively with their providers.
Correct tests are ordered for proper diagnosis. Appropriate medications are given to treat conditions. In addition, coordination of care is enhanced. Records are available for patient??™s appointments. Duplicate test are not ordered because previous test results are accessible. We use the electronic medical record and barcoding medication management system at the health care facility I work at and I have noticed that more appropriate care has been provided to patients because of these technologies. Being able to access past medical records or test results by just one click of a button has increased efficiency.
Also medical errors have been reduced by administering medications by scanning the patient and then the medication. According to Anne Gauthier in the article A Need to Transform the U. S. Health Care System: Improving Access, Quality and Efficiency, ??? Over a third of the population is uninsured, unstably insured, or underinsured. With health care costs on the rise, affordability is a key concern for many working families.
Gaps in insurance coverage and high out-of-pocket spending hinder patients??™ access to care and lead to skipped medical test, treatments and follow-up appointments.??? (Gauthier & Serber, 2005)When care is affordable, basic health insurance coverage is provided for all with adjustments made for income and resource availability. Patients are not excluded from health insurance coverage because of ??? pre-existing conditions.??™ There are no lifetime limits to spending for health plans. People are able to receive the medical attention they need without fear of cost. Patients are able to undergo medical test and/or treatment if needed. They can afford to go to their follow-up appointments. Patients can see a specialist when warranted.
They can afford to fill all of their necessary prescriptions. (Singer, 2008)My father is underinsured. He is an independent contractor.
He makes enough money to make ends meet. He pays nearly $600 per month for substandard insurance for just himself. He has no past medial history because he rarely seeks medical attention because he is afraid of the associated costs. Recently, my family and I decided to intervene and try to convince him to go for a physical and receive the routine tests that are needed for a man of his age. Reluctantly, he agreed. But then I started to think of the associated costs. I actually asked him to delay his physical so I could make sure he had enough health insurance coverage just in case he needed more medical care as a result of the physical. I was afraid if he was diagnosed with something, that would be a ??? pre-existing conditions??™ preventing him from receiving better coverage in the future.
When I was researching other insurance options for him, I could not help but to think how wrong it was that I had to delay his care to make sure his insurance would cover his health expenses. I did upgrade his insurance and he did have his physical. We are now waiting for some of the test results. I still worry that he does not have enough health insurance coverage. But these issues are common. Health care access barriers affect all of us.
Reforming our health care delivery system to improve quality of care is essential to address availability, appropriateness, and affordability of healthcare. Reforms should improve access to the right care at the right time in the right setting for the right price. They should keep people healthy and prevent common, avoidable complications of illnesses. Thoughtfully constructed reforms would support greater access to health-improving care. BibliographyFiscella, K. (2011). Health Care Reform and Equity: Promise, Pitfalls and Prescriptions.
Annals of Family Medicine 9(1) , 78-84. Gauthier, A., & Serber, M. (2005). A Need to Transform the U. S. Health Care System: Improving Access, Quality, and Efficiency. The Commonwealth Fund , Vol 21.
Moorhead, S., & Slavik Cowen, P. (2011).
Current Issues in Nursing, Eighth Edition. Missouri: Mosby Elsevier. Singer, D. (2008, February). The Health Care Crisis in the United States. Monthly Review, An Independent Socialist Magazine . Stakowski, L. (2004).
Trends in Nursing, 2004 and Beyond. Topics in Advanced Practice Nursing .
