What are the significant barriers to healthcare access and their variation across demographics?
The Key Assignment will include 2 parts. Part 1
(Week 4 IP) will include the planning and preparation of your research topic. Part 2 (Week 5 IP) will include reporting on the results of your research.
Part 1: Tasks Week 4 IP
Update this section of your document based on feedback from the peer review and instructor.
Part 2: Tasks Week 5 IP (New Material)
Reporting
Report on the results of your research. The new section of your document will include the following:
Report the major findings. Data analysis will include demographics, descriptive statistics, and statistical analysis.
Restatement of research purpose, cases, and time periods.
Suggest clear, specific proposals for action:
who should do what by when.
Use charts and tables to communicate the results: reports, briefings, and executive summary.
Summarize all the graphic presentations, charts, and tables.
Assessment of correspondence between predictions based on theory and actual observations.
Present evidence to support recommendations.
Summarize the implications of the research.
Requirements: 3-5 new pages( total of 8-12 pages)
Healthcare Policy and Access to Care
James R Williams
Colorado Technical University
PA605-2304A-01
Professor William Clements
September 24, 2023
Healthcare Policy and Access to Care
Introduction
Healthcare policies play a pivotal role in promoting access to quality care. Policies in the United States healthcare system help shape and protect the population’s well-being. They impact various issues, from healthcare costs to patient privacy to delivery methods. Different sets of healthcare policies address multiple aspects of operations. Patient care policies are designed to protect patients and promote safe, effective and quality care. They outline protocols and procedures on how healthcare professionals should perform their daily operations including responding to specific medical situations. Drug policies protect human rights by outlining procedures around handling, recording, and administering pharmaceuticals. This helps prevent errors related to drug handling, mitigate the harms of drug use and provide medical assistance and treatment. Drug policy also combats drug misuse or addiction by controlling demand and supply. Another important healthcare policy is security and privacy policies. HIPPA and other privacy and security policies safeguard patient confidentiality by guiding employees on handling situations that pose security threats to patients’ data and information. Employee health policies protect employee health and well-being to ensure productivity, morale, and engagement. Employee health is crucial to effectively running a facility. As such, lawmakers have set policies to minimize risks of exposure to chemicals and illnesses in the workplace and maintain healthcare professionals’ well-being (University of St. Augustine for Health Sciences, 2021). These policies establish guidelines and rules that benefit patients, healthcare workers, healthcare organizations and the healthcare system, ensuring the best care for patients.
Despite the benefits, the U.S. healthcare policy has been criticized, owing to paradigm shifts over the years. The healthcare policy is characterized by a complex interplay of healthcare delivery models, insurance structures and local, state and federal laws. This has attracted questions regarding the effectiveness of the U.S. policy in promoting access to quality, affordable and equitable care. This research study aims to identify critical issues in healthcare policy and barriers preventing access to care. The study will contribute to the ongoing discourse on healthcare policy reform by recommending strategies to improve U.S. healthcare policies and access to care.
Literature Review
Historical Perspective on Healthcare Policy Development and Its Impact on Care Access
The U.S. healthcare policy has evolved over the years, significantly impacting access to care. The government involvement in healthcare has increased. 2021 government spending increased by 2.75 to reach $4.3 trillion (American Medical Association, 2023). Also, the American government’s influence on health insurance has increased over the past century. The government established Medicare and Medicaid in 1965 and has since expanded its spending in this sector, accounting for 33% of all insurance plans and 48% of employer-based programs. The ACA has reduced the number of uninsured and increased access to healthcare services. In 2015, 37% of the population had public insurance coverage, 55.7% had employer-based insurance, and 16.3% had private coverage, which they used to receive care (National Academies of Sciences, Engineering, and Medicine, 2018).
Current State of Access to Care across the United States
Today, the healthcare industry is an integral part of the U.S. economy, with healthcare spending representing one-sixth of the nation’s GDP. Yet, disparities in access to care persist, disproportionately affecting low-income populations, underserved communities and minority groups. The main challenge confronting the healthcare policy is the high proportion of uninsured. The rise in premiums prevents many people from obtaining health insurance coverage. Another issue in health policy relates to the underlying costs of healthcare. Variations in health insurance, quality and affordability characterize the current state of healthcare access. The U.S. health system has significant inequalities in access to care and health outcomes. Racial disparities exist in coverage, with the highest uninsured among racial and ethnic minorities. According to Yearby et al., 2022), Black people are 1.5 times while Latinos are 2.5 times more likely to be uninsured than Whites. This has led to inequalities in access to care, as demonstrated in poorer health outcomes, increased risks for chronic illness, increased mortality and low life expectancy among minorities.
Barriers to Healthcare Access
Lack of health insurance has been established as a significant barrier to access to care. Studies have consistently recognized the role of inadequate insurance coverage in hindering access to healthcare services. O’Lawrence (2019) found a relationship between a lack of insurance and inequitable access to care. The author identified other barriers, including lack of availability of services, high costs of care, and lack of culturally competent care. These barriers can result in delayed or forgone medical treatment, preventable hospitalizations and financial burdens, unmet needs and inability to get essential medical services, preventive care, and medications, ultimately impacting patient’s health outcomes. Moreover, lack of insurance exacerbates disparities in care access, disproportionately impacting low-income individuals and underserved and minority communities. Besides financial barriers, particularly among uninsured and low-income people, transportation issues are also tied to worse access to care. Transportation costs, inadequate infrastructure, long distances and other transportation issues have been associated with insufficient access to care, particularly among individuals with chronic diseases and low income. Research findings indicate that 5.8 million people delayed medical care due to a lack of transportation in 2017 (Wolfe et al. 2020). Additionally, sociocultural factors such as language barriers, stigma, biases, shortages in healthcare staffing and work-related factors negatively affect access to care. Katz et al. (2018) reported that patients with social complexity factors have poorer outcomes based on primary care indicators for prevention, including chronic disease management, breast cancer screening, and use of healthcare services.
Best Healthcare Policy Practices to Promote Access
Lawmakers can take various steps to improve U.S. healthcare policy and address associated challenges. Firstly, they can expand Medicare and Medicaid eligibility to make health insurance accessible to more individuals, particularly those in vulnerable or low-income populations. The current income limit for Medicaid Eligibility is 138% of the federal poverty level (Healthcare.gov, 2023). Lawmakers can raise income eligibility threshold levels above the national poverty level so that low and moderate-income people with incomes above the threshold can become eligible for subsidized coverage. They can also adjust work requirements, lifetime caps, household size, age, family status, disability and other factors surrounding the program eligibility to create opportunities for more individuals to obtain insurance coverage. Besides, policymakers should enact policies to regulate insurance premiums, out-of-pocket costs, and subsidies for low-income families to make insurance coverage affordable. In addition, they should consider implementing single-payer systems, hybrid models or public options to achieve universal healthcare coverage. This will ensure all Americans, including those with financial constraints, access healthcare services. Legislators should develop health equity initiatives to address health disparities among minorities, underserved, and vulnerable populations. They should also identify and adopt cost-effective resources to promote affordable care. Furthermore, lawmakers should consider effectively incorporating technology in healthcare and addressing public infrastructure and social determinants of health to facilitate access to equitable care.
Theoretical Framework
Health Equity Impact Assessment (HEIA) Framework
The HEIA framework is fundamental for evaluating healthcare policy’s impact on access to care. It is a systematic approach to assessing health equity impacts of policies, programs or initiatives as well as unintended consequences on marginalized or vulnerable populations (CAMH Health Equity, 2023). This study draws on the HEIA framework’s basic principles to understand healthcare policy’s impact on access to care. For instance, the research emphasizes empirical evidence and analysis to understand the implications of policy decisions, as proposed in the framework. The study also identifies and recommends addressing disparities in access to care, particularly among marginalized communities. HEIA places particular emphasis on health equity. It also recognizes the influence of various factors on health, including education, income, health literacy and housing. Consistent with this tenet, this study identified multiple barriers to access. In addition to the HEIA tool, health belief theory (HBM), institutional theory and social capital theory were utilized to understand the relationship between healthcare policy and access to care. The HBM posits that an individual’s willingness to change their health behavior primarily comes from health perception. The study applied this theory to analyze how healthcare policy decisions influence people’s beliefs and motivations regarding seeking care. For instance, it guided understanding of how ACA’s individual mandate coverage affects personal beliefs on potential financial hardships related to healthcare, leading to more people securing coverage. Institutional theory was applied to understand how healthcare organizations address language and cultural barriers and how they can achieve culturally competent care.
Research Questions
1. What are the significant barriers to healthcare access and their variation across demographics?
2. How can health belief, social capital theory, institutional theory, and Health Equity Impact Assessment (HEIA) framework be applied to evaluate the impact of health policies?
3. What strategies can help address SDH and promote equitable access to care?
4. How does policy advocacy shape healthcare policies, and how can it be strengthened for improved access?
Methodology
Existing literature served as a primary data source during this research. The researcher performed keyword searches using academic databases such as the National Institute of Health, National Academies of Science, BMC and PubMed to identify studies related to healthcare policies and access to care. The rigorous inclusion and exclusion criteria during the studies’ selection helped ensure the selected literature’s relevance and quality.
References
American Medical Association. (2023). Trends in health care spending.
CAMH. (2023). Health Equity Impact Assessment.
Katz, A., Chateau, D., Enns, J. E., Valdivia, J., Taylor, C., Walld, R., & McCulloch, S. (2018). Association of the social determinants of health with quality of primary care. The Annals of Family Medicine, 16(3), 217-224. 10.1370/afm.2236
National Academies of Sciences, Engineering, and Medicine. (2018). Healthcare utilization as a proxy in disability determination.
O’Lawrence, H. (2019). Lack of insurance coverage affects access to healthcare. European Journal of Environment and Public Health, 3(1), em0021.
University of St. Augustine for Health Sciences. (2021). Healthcare Policy: What Is It and Why Is It Important?
Wolfe, M. K., McDonald, N. C., & Holmes, G. M. (2020). Transportation barriers to health care in the United States: findings from the national health interview survey, 1997–2017. American journal of public health, 110(6), 815-822. 10.2105/AJPH.2020.305579
Yearby, R., Clark, B., & Figueroa, J. F. (2022). Structural Racism In Historical And Modern U.S. Health Care Policy: Study examines structural racism in historical and modern U.S. health care policy. Health Affairs, 41(2), 187-194.
Healthcare.gov. (2023). Medicaid expansion & what it means for you. .)
Healthcare Policy and Access to Care
James R Williams
Colorado Technical University
Graduate Research Methods for Public Administration
Professor William Clements
September 21, 2023
Healthcare Policy and Access to Care
Introduction
Brief overview of the significance of healthcare policy in promoting access to care
Healthcare policy is crucial because it increases access to care by patients. It also benefits the healthcare system by preventing medical errors and associated costs (University of St. Augustine for Health Sciences, 2021).
Statement of the research problem: identifying shortcomings of current healthcare policies and barriers to access to care.
The critical problem in the U.S. healthcare policy is insufficient insurance coverage. The premiums are rising, reducing the number of citizens who can afford insurance coverage. Another issue in health policy relates to the underlying costs of healthcare.
Purpose of the study: to propose strategies to enhance healthcare policy and improve access to care.
II. Literature Review
A. Historical perspective on healthcare policy development and its impact on care access
B. Current state of access to care across the United States.
C. Barriers to healthcare access include inadequate health insurance coverage, staffing shortages, transportation, work-related factors, and sociocultural factors like stigma and bias, and language barriers (Wolters Kluwer, 2022).
D. Best healthcare policy practices to promote access include identifying and implementing cost-effective resources, expanding insurance coverage, addressing language barriers and stigma among the medical community, and leveraging technology.
III. Theoretical Framework
A. applying the Social Determinants of Health (SDH) model to identify key determinants affecting access to care.
B. Analyzing the role of policy advocacy and social justice theory in shaping healthcare policy for improved access
C. Applying the Health Belief Model, Social Capital Theory, and Institutional Theory to assess the impact of health policy on equity in access.
D. Utilizing the Health Equity Impact Assessment (HEIA) framework to evaluate the impact of health policy on access
IV. Research Questions
A. What are the significant barriers to healthcare access and their variation across demographics?
B. How can health belief, social capital theory, institutional theory, and Health Equity Impact Assessment (HEIA) framework be applied to evaluate the impact of health policies?
C. What strategies can help address SDH and promote equitable access to care?
D. How does policy advocacy shape healthcare policies, and how can it be strengthened for improved access?
V. Methodology
A. Research Design
1. Review existing research that combined both qualitative and quantitative approaches.
a.) Search Strategy: The study will focus on studies related to healthcare policy and access to care. Keywords such as healthcare policy, critical issues in health policy, access to care, healthcare access, mixed methods, peer-reviewed articles, qualitative research, scholarly journals, and quantitative analysis will be used to search for studies for review.
b.) Database Selection: Studies available in PubMed, Wolters Kluwer, NHI, Academic databases, and Web of Science.
c.) Inclusion and Exclusion Criteria
Inclusion Criteria: Studies published within the last five years (from 2018 to 2023).
Exclusion Criteria: Studies published before 2018 and studies unrelated to health policy and access to care
d.) Data Extraction: studies with proper description of qualitative and qualitative methods in health policy and access
B. Data Collection Strategy and Instruments
1. Strategy: Systematic searching, retrieval, and analysis of relevant datasets, reports, and studies.
2. Instruments: Database search queries and search parameters.
C. Sampling Approach
1. Purposeful sampling: using inclusion and exclusion criteria, comprehensive data search, and screening of search results.
D. Data Analysis Strategy
1. Meta-Analysis of Quantitative Data
2. Qualitative data analysis through content analysis: Content Analysis of Textual Data
3. Comparative Analysis of Policy Impact
E. Review and Test the Methodology
1. Peer Review and Expert Input:
VI. Work Plan
Duration: 3 months
A. Research Timeline
Month 1: Project Initiation and Planning
Week 1-2: Define Research Objectives and Scope:
Clarify research objectives and questions.
Determine the scope of the literature review.
Week 3-4: Develop Search Strategy and Keywords:
Creating a comprehensive search strategy.
Generating a list of keywords and controlled vocabulary terms.
Month 2: Data Collection and Initial Screening:
Week 1-4: Database Search and Data Collection:
Performing systematic searches in selected databases.
Collecting relevant studies, reports, and documents.
Organizing collected literature into a structured database.
Week 5-8: Initial Screening:
Screening titles and abstracts for relevance.
Creating a list of studies for full-text assessment.
Month 3: Full-Text Assessment, Data Quality Assessment, and Data Synthesis:
Accessing to full-text articles and documents
Week 1-4: Full-Text Assessment:
Obtaining and assessing the full-text versions of selected studies.
Applying inclusion and exclusion criteria.
Documenting reasons for exclusion.
Week 5-8: Data Quality Assessment and Data Synthesis:
Evaluating the quality and reliability of selected literature.
Documenting the quality assessment process and results.
Analyzing and synthesizing extracted data.
Summarizing key findings and trends in the literature.
End of Month 3: Data Analysis Phase Complete
Resource Requirements:
Researcher
Access to academic databases
Access to academic databases and digital libraries
Reference management software
Project management tools
Quality assessment tools or criteria
References
University of St. Augustine for Health Sciences. (2021). Healthcare Policy: What Is It and Why Is It Important?
Wolters Kluwer. (2022). Five key barriers to healthcare access in the United States.
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