Delivering Health Care in America on Vulnerable, Underserved Populations

Running head: HEALTHCARE AMONG VULNERABLE POPULATION 1 

Delivering Health Care in America on Vulnerable, Underserved Populations 

Student’s name 

Institution 

Delivering Health Care in America on Vulnerable, Underserved Populations 

Introduction 

Although America can boast of a developed system of quality health care, several groups within the population, particularly the vulnerable individuals, have had healthcare quality problems, an increased burden of poor health, and experiences of disparity within the healthcare system. The minority, vulnerable, and underserved populations often face numerous barriers to accessing quality healthcare service, leading to adverse healthcare outcomes. The Department of Health and Human Services identifies susceptible and underserved populations as communities that entail members of the minority population who have undergone health disparity. Vulnerable population involves the group of individuals who have, or are prone to have, health conditions that make it challenging in their attempts to carry out personal productive activities. 

Healthcare professionals and the federal government have made efforts to address the problems with the delivery of healthcare services to these communities and ensure that all Americans have access to basic quality care. However, there is considerable interest in finding better techniques for meeting health care needs for this population. The paper will examine the various vulnerable and underserved groups and the challenges they experience to get healthcare. Further, it will describe the initiatives and programs implemented by healthcare professionals and the government to meet the needs of its people. The paper will finalize by recommending what the country and healthcare professionals should do to meet the needs of vulnerable populations. 

Definition of the Vulnerable and Underserved Population 

Social factors may worsen the health and healthcare of numerous vulnerable populations in America. Vulnerable populations experience inadequate access to healthcare, high rates of morbidity and mortality, and more risk factors compared to the general population. In the U.S., various groups are regarded as vulnerable populations, such as the economically disadvantaged people, ethnic and racial minorities, and individuals with chronic illness, among others. 

Economically disadvantaged or homeless people 

The economically disadvantaged group of people is prone to chronic conditions with severe effects. Additionally, individuals with low income are disproportionally ethnic and racial minorities. Since these individuals live in deplorable conditions, there are high chances they may have any kind of medical coverage, and therefore, have few interactions with the healthcare system. They often have co-occurring conditions, implying that they may have mental and other behavioral issues such as depression, chronic medical illnesses like diabetes and obesity, and substance abuse. A 2017 research by the Department of Housing and Urban Development revealed that on a single night, there are approximately 554,000 homeless people in the United States (The U.S. Department of Housing and Urban Development, 2018). Homeless people are at considerable risk of having adverse health-related issues. Besides, they are unlikely to have a reliable source of primary care and more likely to ignore their health conditions. 

Chronically ill and disabled 

Individuals with chronic diseases are prone to have poor health outcomes since they have to spend more funds and resources on their healthcare. Similar to chronically ill people, the disabled often have numerous interactions with the healthcare system, and they are likely to have healthcare accessibility challenges. 

Population in remote and rural areas 

These individuals often have challenges accessing hospitals and other healthcare facilities. In case of emergencies, it is hard for ambulances to get to them on time. Moreover, due to their location, they experience geographical isolation, have fewer job opportunities, and hence lower socioeconomic status. Native Americans residing in the reservation are also vulnerable. Their life expectancy is lower; they have inadequate education and higher poverty rates. These communities have challenges accessing healthcare, partly because they are underfunded, and they experience discrimination when they visit healthcare centers. 

Young children and elderly individuals 

Due to their age, elderly people are weak and prone to multiple illnesses, thus facing difficulties fending for themselves. Also, weakness and susceptibility to diseases lead to a decline in their income. Further, the elderly are more vulnerable to health conditions because they have low immunity and often have multiple medical conditions. Conversely, children are too young to take care of themselves and always rely on others to serve their interests. 

In addition, there are several other subgroups classified under the vulnerable population. They include the minorities, the LGBT community – who face discrimination in health centers, high-risk pregnant women and their infants, underinsured and uninsured people, and underserved people such as those living in areas with a shortage of health professionals, refugees, frontier residents, and migrant workers. 

Healthcare Concerns of Vulnerable Population 

The vulnerable and underserved populations are barred from accessing the required health coverage and health care service. Access is the timely availability of health services to attain the optimum outcome for a patient. Some of the barriers that vulnerable people face to access health care include low health literacy, inadequate or unavailability of professional health care providers (e.g., in medically underserved areas), lack of medical coverage, inconsistent sources of care, and high cost of healthcare. The healthcare system in the U.S. is burdened with disparities related to various factors such as healthcare insurance, socioeconomic status, and geographical access to health services (VanderWielen et al., 2015) 

To begin with, the lack of health insurance coverage is among the top obstacles to accessing healthcare. Medical coverage is essential as it assists in reducing the financial burden of getting healthcare. People who have no coverage are less likely to get medical care and more likely to be in poor health. They may delay seeking care, get less attention, get less diagnosis of their condition, pay more money on health care and be in-debt, or get the care that does not meet their specific needs. Vulnerable individuals do not have access to proper medical care coverage because of the cost. Individuals with lower incomes are often uninsured, and vulnerable people account for more than 50% of uninsured individuals (Majerol et al. 2015). Lack of coverage results in an inconsistent source of care. For instance, people without coverage may only get medical services by going to free clinics and cheap hospitals or treatment centers only when they get some money. Uninsured individuals are less likely to get preventative healthcare for chronic illnesses such as cancer, cardiovascular diseases, and diabetes. Furthermore, studies indicate that people who regularly visit the doctor have better health results since they get quality care services (Buchmueller, 2005). 

Nonetheless, health insurance alone cannot solve all barriers to healthcare. Unreliable and inconvenient transport can ruin consistent access to health services, resulting in adverse health outcomes. Research indicates that lack of transportation can make patients, especially those from vulnerable populations, skip or delay medication, miss or reschedule appointments, and postpone care (Syed, 2013). Transport barriers are associated with a late-stage diagnosis of various medical conditions. Geographic isolation is closely related to the transport barrier because individuals living in remote areas are more likely to experience poor transport. Vulnerable rural dwellers struggle to access healthcare centers in comparison to persons residing in suburban or urban areas. Statistics revealed by the American Hospital Association indicate that approximately 57 million Americans stay in remote and rural areas (Pollack, 2019). Rural hospitals face challenges such as limited personnel, limited resources, and other financial constraints. 

Another factor that can hinder access to quality healthcare and increase the risk of poor health outcomes is inadequate healthcare resources and staff. For instance, if there are few medical professionals or a few hospitals in a remote area, the patients will have to experience longer waiting times and delayed service. Additionally, most health centers in rural areas cannot offer services to patients with chronic health conditions due to the lack of adequate facilities. Communities residing in rural areas are accustomed to having few clinicians. The country has an impending physician shortage even in the urban area, but residents in rural areas feel the effect even harder. Data from the National Rural Health Association indicates that there are 39.8 healthcare professionals for every 100,000 individuals in rural setups. The disparity is evident when the ratio is compared to the urban statistics, which put the healthcare professionals to public ratio at 53.3 per 100,000 (National Rural Health Association, 2010). 

The majority of the vulnerable population has limited education about health centers and poor health literacy. Health literacy is the capability to receive and understand necessary information about health care services and coverage, utilize the information to make an appropriate decision, and follow professional medical instructions. Low health literacy may cause patients to have challenges finding services and health centers, filling complicated health forms, sharing their medical history with medical providers, managing chronic health conditions, seeking preventative health care, and understanding prescriptions. Low health literacy is more common among the vulnerable population, including older people, previously uninsured people, minority populations, medically underserved individuals, and recent immigrants. 

Finally, another common challenge that hinders vulnerable individuals from accessing healthcare is communication barriers. Some of the exposed individuals have difficulties communicating with healthcare providers. Communication barrier is caused by several aspects, including literacy levels, disabilities, health status, culture, and foreign language challenges. Communication challenges may hinder an individual's ability to provide informed consent, getting their problem solved, expressing treatment preference, and complying or understanding with treatment options. Also, it's a hindrance to persons who seek private providers who are asked to offer patient-specific and culturally sensitive services. 

Initiatives to Meet the Need of Vulnerable Groups 

Healthcare professionals have made various initiatives to address the needs of the vulnerable and underserved. Helping out people who go through challenges of accessing quality healthcare can lead to improved health outcomes in the vulnerable population and save funds by preventing costly medical interventions. 

First, to address the issue surrounding geographical access to medical centers, and initiative “MedStar Health's Medical House Calls Program" was established to provide fulltime access to health services and on-call doctors for disabled and elderly patients who have challenges leaving their homes. The initiative helps patients who might experience repeat hospitalization or institutionalization since they are not able to access ambulatory services. Patients using house calls have 17% lower Medicare cost, 27% less nursing home bed days, and 9% less bed hospital admissions (Ho, Kuluski, & Im, 2017). Another initiative that addresses transport challenges for vulnerable is Denver Health. After realizing that lack of transport hugely affected patient access to healthcare services, Denver Health started to offer taxi and bus vouchers to patients. Additionally, rideshare giants Lyft and Uber revealed their plans to halt the growth of share gaps caused by transport issues. Healthcare professionals and organizations have been creating their relationship with these transport companies and other specialized medical transportation services. 

Second, healthcare professionals have made efforts to motivate students to take studies that would lead them into the professional field of healthcare to increase the number of physicians. This will help address the issue of shortage of clinicians in rural and even urban areas. Medical institutions and students in the U.S. have responded positively to training opportunities in remote places. For example, the Primary Care Progress group has enrolled students from the Medical Campus of the University of Colorado Anschutz to work with the Aurora community and build an interdisciplinary student free clinic. Another program running at Virginia Commonwealth University, collaborating with a free clinic in the locality, promoted teaching practice experience for students who take part. The primary care learning experience connects students in the medical field, interpreters, and other professions to provide healthcare services to uninsured patients. These participants are trained to work efficiently and acquire teamwork skills to tackle educational, communication, accessibility, and socioeconomic hurdles. 

Third, the introduction of universal health care. Universal health care has been a major area of debate for many nations in the world. While some countries have succeeded in establishing health care services for its citizens, others are yet to do so because of the underlying politics and laws in the country. Obamacare was the first universal healthcare system adopted in the United States in 2010. This primary health care system was implemented during Obama's presidency when the promotion of universal health care was given priority in the country. As of 2017, approximately 74 million Americans were either low-income earners or people living with disabilities. This number translates to about 23% of the nation ( (Ho, Kuluski, & Im, 2017) . Health cover was required for all American citizens to enable them to access quality health care. Medicaid is a program run by the federal government to provide health coverage for individuals with limited resources and income in the United States. Therefore, the Medicaid project in America has been able to cater for the vulnerable people who cannot afford the costly insurance covers (Hirsch, 1994). 

Fourth, the introduction of telemedicine in the healthcare industry to help in addressing the problems. Telemedicine entails the utilization of conference calls, videoconferencing, and other technologies for medical procedures, consultations, and examinations. The strategy can improve access for people in isolated rural areas. Although the method is often used for a specialist to access patients in remote and other rural places, it can be used to increase access to primary care. It is also excellent for reducing expenses and time travel but needs investments in expensive and sophisticated equipment. Telemedicine and incentives for health care professionals working in underserved locations promote the availability of prehospital emergency services. 

The American government has also dedicated various programs to reduce barriers to healthcare. For instance, the HRSA Bureau of Health Professions solves the issue of professional shortage in the health sector by identifying areas of need and providing various funds and grants for health professional training and education. The government project offers technical assistance and funding to health centers, which have been approved to provide care for underserved, low-income, and uninsured populations. The American Recovery and Reinvestment Act grants funds to address issues related to accessibility to healthcare, the basic needs of the expanding Medicaid and uninsured people, and the generation of new health care jobs. Some of the federal programs established to improve access to healthcare include the Indian Health Service Scholarship, Medicare HPSA Bonus Payment, Exchange Visitor Program, Rural Health Clinic Program, and the Health Center Program, among others. 

Recommendations 

Although healthcare professionals and the U.S. government have attempted to address the barriers of delivering healthcare to vulnerable and underserved individuals, they have left numerous gaps that need to address. To begin with, health professionals can conduct public awareness campaigns to help educate the vulnerable people about opportunities that are currently available but underutilized. They can organize training for the communities in rural areas, conduct door-to-door campaigns, or plan for free medical camps in remote areas to raise awareness. Additionally, training can be performed for medical care practitioners to help them learn how to communicate with illiterate patients. Some of the tactics physicians can use to communicate with such audience include slowed verbal interactions, use of simple vocabularies, seeking for translators if they do not speak English, read instructions for the patients, ask open-ended questions, draw or point to pictures, offer or direct consumers to coverage to care materials, and note important information and share it with the patients. 

Further, the government can build more hospitals in rural areas and increase professionals and resources in the available hospitals. Within the current hospitals, health professionals can build hospital-community collaborations to bring together various organizations and individuals to tackle the implementation barriers. Their unity will create a substantial positive effect that could not be achieved if they worked independently. The government can also offer additional investment for creating, analyzing, and supporting effective health care delivery models developed to meet the exact need of the vulnerable population. Moreover, the government and healthcare professions should support the development and evaluation of healthcare quality measures and measurement techniques for vulnerable individuals. Finally, payment to health providers and health plans should encourage quality health care and enhanced functionality and health status for all patients, including vulnerable populations. 

Conclusion 

This research paper has comprehensively discussed the various vulnerable and underserved groups, including the economically disadvantages people, the elderly and young children, ethnic and racial minorities, the population in remote and rural areas, and individuals with chronic illness, among others. These groups face numerous challenges such as low health literacy, geographical isolation, transport challenges, inadequate or unavailability of professional health care providers, lack of medical coverage, communication barriers, inconsistent sources of care, and high cost of healthcare. Further, the paper has described the initiatives and programs implemented by healthcare professionals and government to meet better the needs of the population, such as motivating learners to join medical schools, programs to reach remote places such as telemedicine and the introduction of universal health care. Quality health care is important for enhancing population health and minimizing health differences. More research is required to understand barriers to the delivery of healthcare to a vulnerable population. Future researchers should come up with an intervention that expands primary access and provide support to healthcare providers. 

References 

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