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Running head: VULNERABLE POPULATIONS
Vulnerable Populations
Maggie Siler
Ferris State University
NURS 340
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VULNERABLE POPULATIONS
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Abstract
Achieving health equity in America is the primary objective set forth in Healthy People 2020
(U.S. Department of Health and Human Services, 2010). The Healthy People series are a set of
national goals determined each decade by federal and private epidemiological research to
improve the health of America. Vulnerable populations such as minorities, the less educated,
and working poor are at particular risk for disparities in healthcare (Harkness & DeMarco, 2012,
pg. 32). Research shows that whether or not one has health insurance can make an important
difference in quality and quantity of care provided, making the uninsured a very vulnerable
population. The uninsured are also at greater risk as they may delay seeking care, compounding
illness and increasing morbidity and mortality leading to additional health and economic risks for
this group (Riedel, 2009). Health care reform is expected to add thirty one million people to the
ranks of the insured. Financial risk due to medical costs for the low income, chronically ill
population is expected to remain high (Evans, 2010). The following paper will discuss the issues
faced by the uninsured in America, analyze the etiologies of this disparity, and examine the
effect of personal bias in health care delivery to the poor, and uninsured American population.
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Vulnerable Populations
Healthcare as a fundamental right has long been recognized by the international
community. Many countries successfully provide national healthcare coverage for all citizens.
The adoption of a national health plan in the United States has been slow, and grudgingly created
(Orentlicher, 2012).
While awaiting full enactment of the problematic Patient Protection and
Affordable Care Act (ACA) (Orentlicher, 2012), approximately forty three million Americans
remain uninsured. Lack of health insurance has many serious implications for the individual, as
well as the entire economy of the United States (Riedel, 2009). This paper examines the
etiologies for lack of insurance and analyzes how individual biases can affect delivery of care to
the vulnerable poor and uninsured in American healthcare today.
The main etiology of the problem lies in economic circumstances. “Individualism and
self-determination, distrust of government, and reliance on the private sector to address social
concerns are typical American ideologies (Riedel, 2009, p. 440)”, especially related to
healthcare. Employer based health insurance plans date back to the 1900’s, and gradually
became an expectation of the average American worker. In today’s economic times, fewer
employers can afford health insurance for their employees. The cost of healthcare, and
insurance, has sky-rocketed in the last twenty years. The rapidly increasing cost of health
insurance has slowed economic and job growth, as companies cannot afford new employees due
to insurance costs for current workers. Many companies have passed on much of the cost
increase to their employees, or created more part time positions without benefits. As a result of
the depressed American economy, with increasing numbers of unemployed/uninsured, and
rapidly increasing healthcare costs the American people are facing a major healthcare crisis.
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State and federal governments do provide various safety net programs. A few examples
are; Medicare, Medicaid, State Children’s Health Insurance Programs (SCHIP), and Veterans
Affairs (VA) clinics (Riedel, 2009). Many of these programs are entangled in red tape with
complicated eligibility, enrollment, and reenrollment requirements that vary by state and agency.
They are often too difficult for the uninsured population to deal with.
The uninsured have difficulty obtaining required care, suffer worse health, and die sooner
than those who are insured (Riedel, 2009). Even if a family or individual is covered by health
insurance, it is no guarantee against unexpected medical costs on an already tight budget (Evans,
2010). The Affordable Care Act leaves many of the newly insured still at major financial risk as
most low income, chronically ill people have greater healthcare costs, and they lack resources
meet necessary out of pocket costs not covered by insurance (Evans, 2010).
Hospitals currently see more insured patients struggle to pay their bills. Medical costs
contribute to approximately one half of all personal bankruptcies (Riedel, 2009, p. 441). The
newly underinsured under the ACA will be more likely to skip testing, medications, and
specialty follow-up due to lack of financial resource (Evans, 2010).
Another part of the problem is simply the business of healthcare. Both insurance
companies and hospitals are big businesses. Successful businesses must remain profitable in
order to stay afloat. Executives of both hospitals and insurance companies make obscene
salaries, including performance bonuses. In 2002 the average salary of the highest paid
administrative staff in eleven studied health insurance companies was fifteen million dollars
(Riedel, 2009)!
The right to healthcare in the United States is insecure for three major reasons. The first
is the governmental aspect of right to payment, instead of the right to receipt of healthcare.
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Finding a provider that will accept various types of public or private insurance can be difficult to
impossible. The second is that the poor must depend on the wealthy to support necessary
healthcare programs. The wealthy are less willing to support such programs as the demands, and
associated costs are so great. The poor hold little political influence, as they lack the financial
where with all to influence Congress. Thirdly, many current government sponsored programs
depend on federal-state partnerships, further diluting responsibility in a national healthcare plan
(Orentlicher, 2012).
Personal biases regarding the poor or uninsured can decrease the quality of care provided.
Often, it is not the fact that the patient is poor or uninsured as much as the fact that many are
obese, dirty, and unappreciative. Those patients are a definite challenge. Not all are uninsured.
There are many ways to make a positive impact on the care for the poor and uninsured.
Simple solutions can include volunteering for health education at community events, free blood
pressure screening at one’s church, and referral to free/reduced cost clinics available in the
community. In the hospital setting, if a patient voices cost concern regarding medications or
hospitalization, a referral to social work or a medication program can be a great help toward
improving outcomes. Even helping a patient with simple hygiene can make a great difference.
The author has even approached a physician to readdress his billing, which ultimately helped an
underinsured patient. The doctor still got paid.
These are very difficult times in healthcare. Everyone is fighting for better quality, and a
bigger piece of the pie. Change is underway, but is slow, awkward, and not universally
accepted. Disparities between the rich and the poor are ageless. How to best resolve these
insurance disparities and further level the field in regards to the provision of quality healthcare to
all are as yet unanswered questions.
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References
Evans, M. (2010, August 9). The new uninsured. Modern Healthcare, 32(28-30), 28-30.
Retrieved from http://0web,ebscohost.com.libcat.ferris.edu/ehost/delivery?sid=15de0bcd-72e0-4c3e-ad40
Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing evidence for
practice. Philadelphia, PA: Wolters Kluwer Health/Lippincott, Williams, and Wilkins.
Orentlicher, D. (2012, Summer-Fall). Rights to healthcare in the United States: inherently
unstable. American Journal of Law and Medicine, 38, 326-348. Retrieved from
http://www.aslme.org;www.allenpress.com
Riedel, L. M. (2009, December). Health insurance in the United States. AANA Journal, 77, 439444. Retrieved from
http://www,aana.com/newsandjournal/Documents/healthinsurance_1209_p439-444.pdf
U.S. Department of Health and Human Services. (2010). Healthy people 2020. Retrieved from
http://healthypeople.gov/2020/TopicsObjectives2020/pdfs/HP2020_brochure_with_LHI_
508.pdf