Policy Problem

Stakeholders

Individuals and families rely heavily on health insurance to manage financial risk. Families with even one uninsured member face embarrassment, anxiety, and the risk of financial ruin. Uninsured families are more likely than insured families to have significant out-of-pocket health-care costs, although spending less overall (excluding premiums). Uninsured people who are hospitalized face a slew of financial problems over the next four years, including a reduction in credit availability and a much higher risk of bankruptcy.

Individuals and families have greater disposable cash to spend on products and services as a result of the personal economic effects. This additional spending has a "multiplier effect," since greater corporate revenues are passed on to suppliers and employees, who then use them. The multiplier effect of Medicaid expansion is estimated to be between 1.5 and 2 times the amount of new federal Medicaid spending, according to one study.

Health-related productivity losses are expected to cost the United States $260 billion annually. Workdays missed due to illness, workers' inability to concentrate due to their own or a family member's health condition, and reduced labor force participation among persons whose health state prevents them from working all contribute to these productivity losses.

Risks of Indifference

The lower quality and accessibility of healthcare for impoverished communities manifests itself in unexpected ways throughout society. Globally, prenatal healthcare is one example: poor women tend to access prenatal care less frequently than wealthy women because of the financial inaccessibility and lack of health literacy on this issue. The combination of the lack of affordability and understanding about reaching out leads to poor women suffering worse birthing outcomes than their wealthier counterparts. These impacts percolate to their children: internationally, children born to women with five or more years of primary school education have a 40% higher survival rate than those born to women with no education.

Domestically, a vicious cycle also exists in relation to health insurance and Medicaid. Lower-income people are more likely to be uninsured and rely solely on Medicaid services, leading them to seek care less often. Being uninsured also leads to limited care coverage for the low-income people, which forces them to grapple with issues of greater magnitude that otherwise would not manifest. These issues involve being unable to access the healthcare system and not being presented with adequate treatment options during a healthcare emergency.

Nonpartisan Reasoning

Besides Medicaid and COBRA, the US government has passed several other policies in attempts to address the impact of economic insufficiency on healthcare access. One example is the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which had several provisions to improve the leverage that working people had on their healthcare access. With the passage of HIPAA, pregnancy could no longer count as a preexisting condition that could lead to denial of health coverage by employers.

HIPAA also enabled workers to retain their health benefits after losing or changing jobs. Finally, HIPAA prohibited employer-based insurance plans from charging higher premiums for employees based on the presence of preexisting conditions or genetic predispositions.

One of the most sweeping healthcare reform legislations—the Patient Protection and Affordable Care Act (ACA), or Obamacare—passed in 2010. There were several provisions of the ACA, such as expanding health insurance coverage through individual health insurance exchanges and employer-provided plans. The ACA also provided subsidies and tax credits to individual consumers based on income levels and number of dependents, expanded Medicaid services for low-income childless adults, and expanded the list of minimum health coverage requirements by private insurers. Upon implementation of the ACA, the number of uninsured individuals in the US declined by 18.8%, and Medicaid enrollment increased by 9.5%.

Policy Options

Given the dire need for action on the front of improving healthcare in impoverished regions, researchers and policymakers have been striving for more high-impact, effective policies implemented in innovative ways. Research conducted by Peters et al. from the Johns Hopkins Bloomberg School of Public Health suggest a multi-faceted approach incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services to reduce disparities in healthcare access and quality.

These approaches involve engaging stakeholders from government, nongovernmental, and commercial organizations to assist impoverished communities, in methods like the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. Improving geographic accessibility would entail the improvement of transportation infrastructure, such as good roads to ensure distribution of medical supplies and drugs, timely emergency referrals, and health worker supervision. It also entails the expansion of remote health services like telehealth that make communication between patients and physicians more convenient.

Improving availability of healthcare services entails tackling the problems of limited working hours of healthcare professionals, long wait times, lack of drug stocks in clinics, and absentee health workers. These issues often lead people’s reliance on unprofessionally trained healthcare providers and shopkeepers who may not have the patient’s best interest in mind. Tackling this issue would require allocation of resources to build higher-quality and accessible clinics.

Financial accessibility has been a very pervasive threat to healthcare access and quality. Even in countries that guarantee universal healthcare, the issue of healthcare affordability is a nuanced one. Oftentimes, challenges like scarcity of public financing, the low salaries of healthcare workers, limited public control over drug and healthcare prices affect impoverished communities with the greatest impact.

Policy suggestions on this front to tackle financial inaccessibility include reducing user fees, which has been associated with improved accountability and involvement of communities, subsidies for outpatient care, specific disease programs, hospital insurance, and services targeted towards assisting the chronically poor. However, a definite, effective solution has yet to be proposed on this front.

Finally, the issue of acceptability of services presents itself most prominently in developing countries like Bangladesh, Burkina Faso, and India. Patients’ perceptions of the quality and effectiveness of medical care can clash with prevailing cultural norms, which can lead to distrust of new medical technology in preference for traditional medicine delivered by shopkeepers or village doctors.

Gender and socioeconomic inequities exacerbate these acceptability issues, as women and the poor tend to be less satisfied by the health services offered compared to men and the wealthy. Adding into consideration the availability and social acceptability of village doctors, impoverished people tend to develop closer relationships with them. Tackling the mindset and cultural differences prevalent, especially in lower-middle income countries, is crucial to breaking the vicious cycle of poverty and healthcare.