Introduction
People use healthcare services to diagnose, alleviate an injury or a disease to maintain and improve the body function to obtain data about their diagnosis and well-being position. Healthcare use can be unsuitable or suitable, of little or high cost. The healthcare scheme has experienced several variations over the last few years. Enhanced and new strategies, medications, trials, imaging machines, and procedures have changed the sequences of healthcare and sites influenced by advancements in analgesia and anesthesia and the evolving minimal and non-invasive techniques. Health insurance coverage is one topic that makes people in the country angry. I understood a while ago not to tell a person next to me that I’m involved in health insurance because many people are mad about the coverage program. People feel that it is too expensive and does not cater to the services needed. Workers feel it is too costly besides worrying about it being available when needed. Clinicians are troubled about how their private health insurance shapes health care; they think of health insurance as a procrustean capable of distorting care.
Currently, health care theorists and economists in the country have their grip; it is with an attitude to insurance that health care providers and patients seem to share. A phrase means that the insurance will take concern with costs out of the transaction between the patient and the health care provider. These gropes arise from patients being frustrated because all of us, despite the complication in the insurance, have an unstated thought about what coverage should entail. There is a time when a person could live in the hospital, and the insurance cover would pay all the costs; the time has changed, and things are not like that anymore. People are troubled with insurance with variations from; the costs, statistics on health care premiums, government inputs pros and cons, locality, and the economic class of an individual.
Body
Health Insurance Policies
Issues in health care policy can be categorized into two subsects; those connected to the fundamental costs of health care and those related to health care. Guidelines related to underlying costs desire is to cut the total health care expenditure by reducing whichever utilization or the value of healthcare while coverage procedure addresses where citizens can get health insurance. Health care is a major aspect of the nation’s policies, with significant debates connected to health care coverage and the total costs of health care (Fiedler & Christen, 2019). The function of health care coverage is to cover citizens from imaginable spending besides facilitating access to health care. Policies related to health insurance coverage include; how insurance is paid for, policies that impact people from being insured, and what insurance coverage and does not cover (Fiedler & Christen, 2019). Debates about reducing the number of people without insurance coverage, whether individuals should get covered if deductions are too high, or how to change the subscription premiums under the federal coverage programs fall under this section.
Several coverage health insurance policies change how various families pay for healthcare, usually by changing the state programs payments on behalf of health care spending burdens shared amongst people with smaller and larger health care needs. However, another suggestion’s objective is to cut the underlying costs of health care by reducing the cost paid for the services or reducing how many individuals receive (Sommers et al., 2017). Such policies can reduce the general health care costs across the system, but it is often either said or implemented. Some policymakers believe that the current state programs on health care coverage are either an inappropriate burden to the taxpayers or too dangerous for the citizens.
The Social Economic Class
At the beginning of 2020, less than 50% of adults were inadequately insured. Despite the Covid 19 virus, statistics show that there has been no significant change in the number of health insured people from far as 2018 (Collins et al., 2020). Evidence also shows that there have been no important variations in the adequacy of coverage amid the duration leading up to the corona outbreak and the time that preceded. However, this changes as the outbreak continue (Collins et al., 2020). Many people in small business practices and adults with low incomes are either not insured by health coverage programs or have spent a significant amount of time not insured in the past years. This is double the initial number than the comparison groups. A significant number of young adults have also not been insured (Collins et al., 2020). As described by the world bank reports, people with low incomes of the poverty level show that the number of uninsured is three times higher than that of adults with a considerable good income. Consequently, such people prescribe underinsured rates two times higher than their counterparts.
Private or public plans bringing their market from an affordable Insurance Care Act to the marketplace are considerably high and uninsured among insured people simultaneously. However, a quarter of adult individuals in an employer’s plan do not have an insurance plan (Collins et al., 2020). This upsurge has been driven by the increase in inadequate coverage from their workers’ employer health care plans. The measure of underinsured includes how much people are deducted or how much they spend, which is calculated as a part of share income. For the past few years, deductions under the same instances have grown in size and prevalence. Inadequate insurance coverage exposes people to increased expenses, which turn into huge medical bills (Raphael et al., 2019). Many insured people at any time in life and those underinsured always complain of paying off medical debts or bills over time.
However, the bills are considerably accelerated between individuals with coverage of all year yet not insured. While their revenue was collective with insurance deducted and even out of their pay expenditure did not cover the threshold for being underinsured. Paying medical bills over time can significantly impact people’s lives (Raphael et al., 2019). From various studies conducted, the bill of adults and the challenges of their debts shows a critical financial challenge. Whereas insurance is not the only factor that shows a person’s accessibility to healthcare, it is the most significant health care aspect.
Geography and Location of the Patient
Entree to health-care can be well-defined by the opportune use of individual health facilities to achieve the best health outcome. Access to health care needs an access into the health care arrangement, admittance to spots of care where the patient can get the desired service, and finding the health care providers who meet their needs and whom people under the same institution can build a relationship based on trust and mutual communication (Medicine et al., 2018). Health professionals note that access to health care promptly is important to enable physicians and patients to prevent diseases, manage chronic conditions, or control acute episodes. These aspects help avoid complications of health conditions of health.
There are various ways to think to get access, a term used to show factors influencing an individual getting medical services. This can be more defined by presenting dimensions of accommodation, accessibility, availability, affordability, appropriateness, and acceptability. This shows access to identify healthcare needs, use, reach, and obtain healthcare services and needs for a fulfilled service (Medicine et al., 2018). The aspect of access can be a variety, and even if there is accessible health care, various factors can impact the ease of access. For instance, the convenience of healthcare professions who are willing to receives an individual insurance; the capability of a patient to reimbursement for the service care; the challenge of placing transport to and from the health care facility; and the ease of making an appointment with a care provider.
People can not get access to care if it is not provided in their locality or if health care will not give the service because of insurance or related issues. Specifically, rural areas have been identified and affected as places that lack an efficient supply of services care from specialists and, in particular, mental health services (Medicine et al., 2018). Even if the services are available, access might be delayed by other related barriers. Once transport becomes an issue, either because of no public transport or time travel is excessive, and the person lacks an alternative way of transportation, the cost of movement is prohibitive. Health care might refuse to see the patients because they failed to make an appointment or their insurance is unacceptable (Medicine et al., 2018. They might be unable to communicate with the patients for language incompatibility, or even their skills cannot help patients’ specific problems. They are waiting for long periods to see or get an appointment to see a provider may deter health cover.
The Affordability to Pay for the Health Insurance
Accessing health insurance is tied to raising or paying the health cover. Financial challenges, specifically among the low-income, uninsured, and low-income people, have been a great challenge in many developed and developing countries. According to the “Commonwealth Fund Survey,” the U.S. is ranked as the last nation for measures of finance accessibility (Ayanore et al., 2019). The study notes on people who are not insured by any health coverage, and a certain percentage of adults who have been operating without insurance cover needed health care services. The lack of an insurance policy has been a significant element of health care disparities.
People between 18-65 with no insurance are more likely than those with private or Medicaid coverage to exhibit problems accessing needed prescription drugs or medical services. Having coverage in health does not mean that it is enough or associated with huge cost-sharing payments of premiums, deductions, and co-payments (Ayanore et al., 2019). The study again groups people not insured as those who say they are covered but are afraid about bills in the hospital, who is paying for the costs, or even who got the selected types of health care because of expenses (Ayanore et al., 2019). A significant number of adults are uninsured or have been delayed to get medical services. This delaying and avoiding correlate strongly with high deduction plans contributed before insurance, poor health, depression, and poverty. But it is relatively not dependent on the individual’s income spent because it is a reduced degree of health. Individuals who spend less of their total incomes on health services might be overburdening their health care strategy when economic worries stop entree to health services.
Health Insurance Premiums
Various factors are associated with health care access. They widely fall into patients’ factors, societal issues, provider, and the health care system factors. Despite great strides in medical therapies, care transitions and adequate coordination remain a great challenge to the cost of health care (Yabroff et al., 2019). Health care practices and providers can be associated with various hospitals. Insurance coverage, however not necessarily to one another, and these factors can change over time. Significantly, care is not explicitly practiced across every insurer, health care system, and medical records can reside in various places to improve the health information and healthcare structure (Yabroff et al., 2019). Lack of continuity and coordination contributes to health disparities, which increases the premium rates offered by insurance covers. Some access challenges are geographical location, language barrier, patient age, and sex.
Ethnicity and Race
Ideally, health care services utilizations show a need for care. However, it is not the case. Various factors affect insurance utilization independently of reflected and need differences, some of which are not remediable among various population groups. Some of these factors are environmental or biological differences among groups (Yue et al., 2018). Others are related to access differences, ease of obtaining services, health insurance coverage, and discrimination by practice providers (Yue et al., 2018). As such, ethnic and racial disparities are found in various sectors in the United States. People of colour, American Indians, and Hispanic origin might be discriminated against and disproportionally represented in lower socioeconomic status in poor paying jobs and low-quality schools (Yue et al., 2018). Racial discrimination based on the residence is the main mechanism through which racism perpetuates and produces social disadvantages. Black Americans and Latino adults are most likely to live in disadvantaged surroundings, experiencing inadequately provided schools with low education quality and attainment (Yue et al., 2018). Such factors can result in ethnic minorities and racial discrimination increase, with high rates of disabilities and chronic illness, increased rates of death, infectious diseases that whites in the same region.
Marginalized communities are more challenged than the majority population in the usual resources of health care. In America, people of colour have an earlier onset of multiple health complications, more rapid in progression and severity, impairment, and increased chances of morbidity through the life course (Yue et al., 2018). These are sequences evident in people with low socioeconomic status as well. Lack of insurance cover, more than any other group or economic barrier, adversely affects the quality of health and service received by marginalized populations. In the U.S, the marginalized population has disproportionately higher insurance rates and lower income, resulting from variation in health care utilization and poor health outcomes.
People With Disability
This is a multidimensional concept. Some health diseases associated with disability causes poor outcomes in extensive health care desires and general health, even though others do not. The disabled groups of people are clinically different. Some individuals have multiple chronic diseases that are stable with being treated and can persist for a long time. Others have severe functional limitations (Chenet et al., 2020). Some have the most critical, persistent characters in health. In contrast, others have a condition greatly triggered by sociological factors such as support from close people, type of housing, and nutrition. It is a term used to describe a person incapable of functioning normally like normal people.
It is a condition that results from genetic disorders, illness, injuries, or environmental conditions. Disability can be progressive, temporal, or intermittent. Therefore, it is not challenging to generalize the relationship between health care utilization through insurance and the condition without mentioning the causes, conditions, or the diseases at large. Some diseases are rare, while others are conditioned linked with disability (Chenet et al., 2020). Without adjusting, the rates of disabled selected populations have been on the verge for more than ten decades. The obsolete number was greatest in the last few years for more people recorded as disabled (Chenet et al., 2020). After separate changes of trends in body mass, race, age, and ethnicity distributions, a significant number of a type of disability continues to show an upsurge over time. Unemployment, low social, economic status, poverty, and poor education remains significant factor associated with disability. People who report the condition are at an increased risk of poor health outcomes such as being obese, mood disorders, hypertension, and fall-related injuries.
Disabled people tend to use more care services than normal people because they have an increased urge for health and medical services to control their conditions. a significant number of disabled individuals have an increased number of visits recorded compared to a normal person visit to a doctor (Chenet et al., 2020). The same people face several difficulties while accessing health care specifically made for their limitation in function. Such barriers include the absence of working elevators, automated doors, ramps, or wide doors enough to pass f they are on wheelchairs or walking on a stick (Chenet et al., 2020). Moreover, they face challenges fighting policies that discriminate against the disabled or even lack policies enforced and designed to fight and accommodate them. They also go through language barrier challenges such as a lack of a person to interpret what they are saying and a lack of large print material.
Sociodemographic and Traits (Risk factors, Income, and Poverty)
People living in rural areas are different from residents living in urban areas in many characteristics associated with health care utilization. Rural people have low wages compared to those living in urban centers and are more likely to call whites in the city. The greatest ethnic and racial diversity are found in local metropolitan areas (Lunn et al., 2017). All groups in these regions are likely to reside in metropolitan regions than the central counties. Fringe counties and large metropolitan areas have a few people with high poverty levels between all the regions.
It is worth noting that those living in rural areas have an increased risk of poor health than people residing in towns. For instance, obesity rates vary with an increase in the rural areas as a few cases are reported in urban centres. In various studies, people living in large towns nationwide county regions showed the lowest obesity cases. In contrast, women in rural regions had the highest number of cases of obesity (Lunn et al., 2017). It has been the same case for several years as people in rural areas show an increased number of chronic heart conditions. The limitation of activities due to severe health conditions in adults is more prevalent in rural areas than in metropolitan areas. In all regions, the magnitude of activities limitation to severe health conditions in both genders generally inclines as the rurality increases.
Spoken Language
Many ethnic and racial minorities experience language barriers and have no or low ability to read, speak or understand English. In the health care settings and utilization of health care facilities, such difficulties can present great challenges to both the health care provider and the patient (Lunn et al., 2017). In a study to review the language barrier of the Latin population in America, results show that health care status, quality care desiring people suffer due to lack of understanding each other (Lunn et al., 2017). If a patient does not know how to speak the language of the health care profession, several adverse effects are bound to happen. For instance, the inability of a person to diagnose a clinician can lead to poor satisfaction of the patient, underuse of the services, and lack of compliance. Individuals who have a problem converse and understanding English are less likely to have a common source of medical services, get few preventive services care, or have significant nonadherence to the doctor’s advice (Lunn et al., 2017). Psychological patients with the same challenge are more likely than their counterparts to receive an effective diagnosis and live the health institution against the doctor’s advice.
Government Pros and Cons
A positive join of health coverage funds is reliant on on dealing and identifying with a extensive variety of aspects entrenched in the aspect’s in every nation. This context is significant, predominantly in emerging nations that challenge different structures and sources and political and institutional conditions (Lunn et al., 2017). It is vital to postulate the kind of challenge the health association insurance that can solve in the finance and health care systems. Moreover, a detailed description of possible outcomes can be operative while backing up application programs to reduce resistance by opposing factors (Lunn et al., 2017). Changing and combining fiscal streams and the upsurge in the influence of health cover arrangement can expand financing and equality of a health care utilization program even though equity improvements in health care systems cannot be credited to the reduction or consolidation in health reserves, but effective to the extent of reducing the current equity.
Better assets will boost the economy of gauge, which will increase the profits providing by the affiliates. Dropping managerial expenses by limiting the health insurance establishments in all regions can be attributed to the merger of employees and top managers. A single player is preferable regarding financial stability and the risk of pooling efficiency (Bazyar et al., 2020). Because of the merger, collecting contributions can be used with several social insurance funds. Additionally, improving the movement in equity reduction and distribution of costs has a bargaining power by creating a monopoly environment. The solitary cover has the inclination and capacity to acquisition the health care carefully to advance the effectiveness of the new programs. It will increase insurance systems since a single mode of insurance is the key provider and player, giving free choices (Bazyar et al., 2020). The system is profitable because it extends the coverage and insurance package favouring members and poorer insurances.
Conclusion
The health care delivery scheme has undergone significant variations in the last years, better and innovative tools, tests, drugs, imagining, and procedures have changed the sequence of sites and care where health care services are provided. People use health care services to diagnose, treat and cure health conditions. Several factors impact health utilization. The need for services impacts various health utilization for particular people. Ideally, need is a primary determinant of health care utilization; however other elements have a clear impact. Such factors include the sex of a person, the locality, race and ethnicity, the language the people speak, age, poverty and its correlates, and the ability to pay the health insurance, socioeconomic class, and health insurance policies. The ability to get access to serve care includes whether the service is available, convenient and time factors affect peoples’ utilization of health care services. For people with disability challenges, accessing such services can be demanding. Various factors coincide and obstruct the need a disabled person needs. The aspect correlates with increased utilization in care, and victims of the same situation normally have worse health outcomes, a high prevalence of diseases, and poorer health services.
References
Ayanore, M. A., Pavlova, M., Kugbey, N., Fusheini, A., Tetteh, J., Ayanore, A. A., … & Groot, W. (2019). Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana. Health economics review, 9(1), 1-15.
Bazyar, M., Yazdi-Feyzabadi, V., Rahimi, N., & Rashidian, A. (2020). What are the potential advantages and disadvantages of merging health insurance funds? A qualitative policy analysis from Iran. BMC Public Health, 20(1).
Chen, L., Zhang, X., & Xu, X. (2020). Health insurance and long-term care services for the disabled elderly in China: CHARLS data. Risk management and healthcare policy, 13, 155.
Collins, S., Gunja, M., & Aboulafia, G. (2020). The U.S. Health Insurance Coverage in 2020: A Looming Crisis in Affordability. Commonwealthfund.org.
Fiedler, M., & Christen Linke Young. (2019, October 15). Current debates in health care policy: A brief overview.
Lunn, M. R., Cui, W., Zack, M. M., Thompson, W. W., Blank, M. B., & Yehia, B. R. (2017). Sociodemographic characteristics and health outcomes among lesbian, gay, and bisexual U.S. adults using Healthy People 2020 leading health indicators. LGBT health, 4(4), 283-294.
National Academies of Sciences, Engineering, and Medicine. (2018). Factors That Affect Healthcare Utilization. In Health-Care Utilization as a Proxy in Disability Determination. National Academies Press (U.S.).
Raphael, D., Bryant, T., & Rioux, M. (Eds.). (2019). Staying alive: Critical perspectives on health, illness, and health care. Canadian Scholars.
Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health—what the recent evidence tells us. N Engl J Med, 377(6), 586-593.
Yabroff, K. R., Gansler, T., Wender, R. C., Cullen, K. J., & Brawley, O. W. (2019). Minimizing the burden of cancer in the United States: Goals for a high-performing health care system. CA: A Cancer Journal for Clinicians, 69(3), 166–183.
Yue, D., Rasmussen, P. W., & Ponce, N. A. (2018). Racial/ethnic differential effects of Medicaid expansion on health care access. Health services research, 53(5), 3640-3656.
write