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

Prof. Name

Date

Identifying a Local Health Care Economic Issue

Access to healthcare and adequate health insurance coverage is a critical healthcare issue affecting individuals, healthcare providers, and healthcare organizations. Inadequate health insurance coverage is a significant economic issue that impacts the ability of individuals to access timely and quality healthcare services (World Health Organization, 2019). In this report, I will focus on the economic issue of inadequate health insurance coverage and its impact on healthcare delivery.

Reasons for Inadequate Healthcare Insurance

The healthcare industry has faced the challenge of inadequate health insurance coverage for many years. This issue was selected because it impacts the entire healthcare system, from patients to healthcare providers and organizations. According to the Centers for Disease Control and Prevention (CDC), 28.9 million individuals in the United States did not have health insurance in 2019, and this number has likely increased due to the COVID-19 pandemic (Centers for Disease Control and Prevention, 2021).

Description of Inadequate Health Insurance Coverage

A community that is particularly vulnerable to this issue is low-income individuals and families. San Francisco General Hospital (SFGH) serves many uninsured and underinsured patients (San Francisco Department of Public Health, 2021). According to a report published by the San Francisco Department of Public Health, in 2019, 10% of San Francisco residents lacked health insurance coverage, and an additional 9% had coverage but reported problems accessing care (San Francisco Department of Public Health, 2021). These individuals are more likely to delay or forgo necessary medical care due to cost and worsening health outcomes.

The Impacts of Inadequate Health Insurance Coverage

The impact of inadequate health insurance coverage on San Francisco General Hospital (SFGH) is evident in its patient population, where most patients are uninsured or covered by Medicaid. This can lead to difficulty accessing care and strain the hospital’s financial resources due to uncompensated care. To address this issue, SFGH has implemented various programs to increase access to care, including financial counseling services and a charity care program for eligible patients (San Francisco Department of Public Health, 2021).

Rationale for Healthcare Insurance

The rationale for inadequate healthcare insurance coverage is rooted in the fundamental principle that access to quality healthcare is a basic human right. The ability to access necessary medical care is essential for maintaining good health and well-being, and lack of access can lead to worsened health outcomes and financial hardship (Cohen et al., 2020).

In the United States, the issue of inadequate healthcare insurance coverage is driven by several factors, including the high cost of healthcare services, the complexity of the insurance system, and the limited availability of affordable insurance options (Cohen et al., 2020).

Reason for Selecting Healthcare Insurance

Personal experiences as a healthcare provider and a community member impacted by inadequate healthcare insurance coverage have influenced my choice of this issue. I have witnessed the negative effects of inadequate insurance coverage on patients’ ability to access necessary medical care and the financial strain it places on healthcare organizations. As a member of the impacted community, I recognize the barriers individuals and families face in accessing care due to financial constraints and believe 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 work as a healthcare provider, my organization, my colleagues, and my community. The issue disproportionately affects diverse and lower socio-economic groups, exacerbating health disparities (Tolbert et al., 2020).

As a healthcare provider, inadequate insurance coverage negatively impacts the quality of care for my patients. Patients may skip necessary medical care due to cost, leading to worsened health outcomes. Patients from diverse or lower socio-economic groups are particularly vulnerable to these negative effects due to social determinants of health, such as poverty and lack of access to healthy food options (Phuong et al., 2022).

The impact of inadequate insurance coverage on my organization and colleagues can also be significant. The organization may face financial strain due to uncompensated care, which can impact its ability to provide quality care and invest in new technologies or infrastructure (Camilleri & Diebold, 2019). This can lead to workforce challenges, such as understaffing or staff burnout.

In my community, inadequate healthcare insurance coverage significantly impacts diverse and lower socio-economic groups. According to a report by the Kaiser Family Foundation, uninsured rates are higher among people of color and individuals with lower incomes (Kaiser Family Foundation, 2020).

Gap Contributing to the Adequate Healthcare Insurance

The gap contributing to inadequate healthcare insurance coverage is the lack of comprehensive and affordable health insurance options, especially for people from diverse or lower socio-economic groups. This is due to high healthcare costs, limited employer-sponsored coverage, and restrictive eligibility criteria for public insurance programs (Kaiser Family Foundation, 2020). Political challenges to the Affordable Care Act have also created uncertainty around future healthcare coverage and access. Addressing these gaps in coverage is essential to promote health equity and improve health outcomes for all individuals (Odeny, 2021).

Policy Solutions

Addressing this gap will require comprehensive policy solutions to improve access to affordable and comprehensive health insurance coverage for all individuals, regardless of race, income, or pre-existing health conditions (Odeny, 2021). This may include expanding Medicaid eligibility, strengthening the ACA marketplace, and implementing policies to address the underlying social determinants of health that contribute to health disparities and insurance coverage gaps.

Evidence to Support the Policy solutions

Evidence suggests that policy solutions to improve access to health insurance can significantly impact health outcomes and financial stability for individuals and healthcare organizations. For example, a study of Medicaid expansion in Michigan found that the expansion was associated 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 is a critical economic issue that affects individuals, healthcare organizations, and communities, particularly those from diverse or lower socio-economic groups. The high cost of healthcare and restrictive eligibility criteria for public insurance programs contribute to gaps in health insurance coverage, 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

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

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

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

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_

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