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Most Americans typically perceive being underinsured as an insignificant problem with few immediate consequences. Inadequate insurance coverage, however, has been a significant and enduring issue. Blumenthal (2001) states that “educating the public about the connection between controlling expenditures and ensuring access to care has been a high priority issue for political leaders”. The relationship between the high rate of the underinsured and the escalating health care costs in the United States is an association that has been studied in detail during the last few years. The number of underinsured Americans has been on a constant increase, a trend that has worried several medical practitioners. The increasing number of underinsured citizens has been perceived to be the root cause of increasing healthcare spending in several American states (Anderson & Hussey, 2001).
Surprisingly, Americans are among the most underinsured citizens of the industrialized world. Most first-world countries offer their citizens healthcare coverage provided by the government, such as the National Health Service in the United Kingdom and universal health insurance in Canada. As a result, these countries have been able to stabilize healthcare costs in a more efficient manner than the United States. The combination of government regulations of healthcare spending and increased access to medical care for the general population make it possible to extend fair and equal care to citizens, while keeping costs at a stable level. The primary disadvantage of this approach, however, is political affiliation. Americans are generally unwilling to support government-controlled healthcare due to misconceptions about government control and communist influences. This is despite the fact that the United States ranks lower than other countries in key measures of health status, such as life expectancy, mortality rates and immunization levels (Schoen, Doty, Collins & Holmgren, 2005, p. 277).
Determining the appropriate definition of “access” is crucial to any formal discussion about healthcare and the under- or uninsured in America. According to Cunningham, “access” is generally referred to as the availability of adequate resources, the overall processes of basic medical care and the kind of care available in relevance to medical need (Cunningham, 1997, p. 174). The availability, quality and cost of health care are important to all American citizens, including healthcare providers.
The situation with underinsurance has been affected by several factors. For instance, welfare reforms have been limiting factors, as they disorient the abilities of the unemployed and individuals in the low income bracket to access medical insurance cover. Low earners may lack medical insurance coverage in situations where the employer does not include insurance coverage in the benefits that he/she accords the employees. Alternatively, these people may simply find it difficult to secure insurance premiums that are adequate for the purpose of effective coverage. Underinsurance makes it difficult for individuals to access medical services, even in situations where there is a significant level of cost-sharing with the government and other stakeholders during the provision of medical care.
There are significant changes taking place in the health insurance industry. For instance, insurance companies and employers are evaluating the manner in which premium increases can be moderated through the provision of new products that are able to ease the burden of the provision of healthcare. The concept of being underinsured is when an individual is insured; but in a manner that does not guarantee adequate financial cover/protection in case of a medical emergency. “To put differently, an individual is underinsured if medical expenses consume more than 10% of his or her income. During 2003, 12% of insured adults were underinsured; this represents approximately sixteen million individuals” (Schoen, Collins, and Holmgren, 2005, p.273). In this regard, medical emergencies would result in an exposure to unmanageable medical costs. Indeed, the increase of underinsured people in the US is a developing challenge, which is associated with severe consequences. Underinsured adults are also more likely to go without the medical treatment they need. “Without attention to insurance adequacy and whether patients receive effective care, an increase in the number of underinsured people could undermine health, productivity, and financial security in the future” (Schoen et al., 2005, p. 273-276).
Making healthcare more available to America’s underinsured populations would reduce the amount and frequency of unpaid medical care cases in the United States, which would in turn result in a reduction in total healthcare spending in the United States. By extending better access to the underinsured, the US healthcare system would not be burdened by outstanding medical costs in the future. We must first acknowledge the exact increase in costs resulting from extended health insurance coverage. Granted there would be various costs involved with extending health insurance coverage to the sixteen million Americans who are underinsured (Hadley & Holahan, 2003, p.W66).
Based on the data collected by the Medical Expenditure Panel Survey (MEPS) “between 1996 and 1998, those who were underinsured during any time of the year received $99 billion in medical care; of this $99 billion, $35 billion was uncompensated care. This is a combination of $24 billion in uncompensated care provide by hospitals, $6.5 billion in uncompensated care provided by clinics and community health centers and $4.5 billion in uncompensated care provided by physicians” (Hadley & Holahan, 2003, p. W 72).
“During this period, uncompensated care accounted for 60% of the care received by the full-year underinsured” (Hadley and Holahan, 2003, p. 70). Hospitals would receive the greatest financial benefit as a result of reduced uncompensated care cases. Hadley and Holahan (2003) also “estimate that 50% of the money currently spent on the underinsured is already provided by government programs” (p. W79). There is already a significant amount of government funding being spent to care for those without adequate health insurance. The long-term reduction in this funding offsets the potential short-term costs incurred with extending health care access to the underinsured (Book, 2005).
Improving access to healthcare for underserved Americans would result in improved primary care for these individuals and a decrease in the number of unmet health needs, disease escalation and avoidable illnesses and hospital visits. Underinsured individuals have a difficult time obtaining primary care services, since the portion of the bill they have to pay out of pocket is too large (Schroeder, 2005). Ironically and unfairly, the United States healthcare system currently provides excessive medical care to some people and not enough medical care to others. This inequality is based on one’s ability to sufficiently insure oneself, which is skewed by the inequality of health resources and the growing disparity between the classes in America (Ayanian et al., 2000).
Unless the American government is willing to bridge the gap between the care that the well-insured and underinsured persons are accorded, there will always be disparities in the access of healthcare services. In fact, there should be no tolerance of disparities with regard to access to basic level of health care. Research has shown that if healthcare access for the entire population was shared by all, cost efficiency and equality would be built into the foundation of the healthcare system. Although these changes may cost more in the short-term than the current situation, the changes will capitulate considerable benefits over time (E. Book, 2005).
As an increasing number of Americans continue to lack adequate access to basic healthcare, the public health and emergency systems in general will suffer to the detriment of even the wealthiest members of society. This forecast for American healthcare ought to be seriously considered in order to avert catastrophe in the future healthcare provision. Because the underinsured must rely on emergency departments for primary care services, these departments are being strained under the weight of 61 million underinsured Americans (Blumenthal, 2001). What this means is that, at some point, America will have to limit or ration its health services to all. The United States will continue to increase spending inefficiently on healthcare while further limiting access to basic medical care services to its people (Mongan & Lee, 2005, p.1263).
Enhancing access to healthcare in America will result in long-term health and economic benefits for the entire nation. There are different costs that are incurred as a result of the lack of health insurance to the American society, as previously mentioned. Some of these unintended costs include “higher taxes, decreased workforce productivity, , higher public program costs with inferior health and reduced social capital” (Miller et al., 2004). Studies have emphasized that Americans have always demonstrated cultural as well as historical bias against the expanded regulatory actions by their government, as they consider such moves to be intrusive, particularly when they necessitate increasing the taxes. In this regard, Mongan & Lee (2005) stated, “The committee on the consequences of uninsurance estimated that diminished health due to inadequate insurance leads to societal costs of $65 billion to $130 billion per year” (p.1262).
In conclusion, should the citizens continue being underinsured? It may become harder for the Americans to be accorded the right medical care. There is an increasing need to address healthcare inequalities and costs in America. Without everyone’s support, “effective restraints on national healthcare expenditures are likely to be elusive” (Blumenthal, 2001, p.767). Whatever side of the debate one falls on, it is undeniable that there is a need to change the phenomenon of underinsured people in this country and the ever-increasing healthcare costs in the United States. “By improving access to healthcare for the 61 million underinsured Americans, the United States healthcare system would reduce the growth in total healthcare costs in the long-term” (Berk & Monheit, 2001).