Health Diversity
Discuss any cultural disparity in health care that you have learned about in this course and that you believe as an APN can impact in practice.
Introduction
Healthcare reform has been a major topic of discussion within the United States. There is growing concern that the amount of people uninsured is causing a tremendous healthcare burden and adding to healthcare disparities. When discussing disparities and barriers to healthcare, there must also be included a discussion on those people who do not have health insurance. Inequities in healthcare pose a threat to not only the uninsured but to all Americans. The U.S. healthcare system presently is expensive and disjointed, which results in health inequities between those with insurance and those who are under or uninsured.
Learning objectives for the module:
At the end of this module, the student will be able to:
1. Discuss healthcare reform.
2. Describe the healthcare crisis.
3. Summarize perspectives of culturally diverse care, rural health disparities, and underserved populations
Readings:
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Andrews, Boyle, & Collins (2020). Chapter 12
Articles:
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Quizhpe, E., Teran, E., Pulkki-Brännström, A., & San Sebastián, M. (2022). Social inequalities in healthcare utilization during Ecuadorian healthcare reform (2007-2017): A before-and-after cross-sectional study.
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BMC Public Health, 22(1), 499. https://doi.org/10.1186/s12889-022-12884-9
Video:
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Health Care Reform: https://youtu.be/EkGGDOp4uUg
Topic 1: Healthcare Reform and Vulnerable Populations
Health care reform can be defined as any improvement of the health care system by realigning health services and health insurance to the unemployed, indigent, uninsured, elderly, and residents of inner cities and rural areas. The comprehensive health care reform law of March 2010 has three primary goals to improve health care:
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To make affordable health insurance available to more people.
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To expand the Medicaid program to cover all adults with income below 138% of the federal poverty level.
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To support innovative medical care delivery methods designed to lower the costs of health care.
Due to the implementation of the Affordable Care Act (ACA), the uninsured rate decreased between 2015 and 2016 by 0.3% and in 2016 the percentage of uninsured was about 8.8%. However, the uninsured rate rose 1.3% to 12.2% which was then approximately 3.2 million Americans. Under the ACA, the uninsured rate dropped to 10.9% at the end of 2016. Several factors may have contributed to the increase and there is a continued push by legislators to fix problems within the ACA in hopes of providing insurance coverage to all. However, that leaves approximately 87.8% of the population in the vulnerable position of having no health insurance.
The impact of having no health insurance or being underinsured is harder on those most in need of health care. Delays in receiving healthcare result in poorer health and higher medical costs, especially for those individuals who already have health issues. The uninsured are also far less likely to have access to clinical preventive services such as smoking cessation assistance, colorectal cancer screening, breast cancer screening, annual influenza immunization, and daily aspirin to prevent heart disease which could save an estimated 100,000 lives each year.
The APN can have a major impact on this vulnerable population by encouraging people to follow their prescribed care regimens and by promoting healthy behaviors in workplaces and communities.
New statistics show that the number of uninsured Americans is decreasing due to the ACA. For additional information see:
The Henry J. Kaiser Family Foundation. (2015). Key Facts About the Uninsured Population. Available at: http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Topic 2: Healthcare Policy and Healthcare Crisis
To complete this topic please go to the following URL:
10 Key Health Issues for the Americas in 2021
https://www.paho.org/en/10-key-health-issues-americas-2021
Topic 3: Summary of Perspectives on the Culturally Diverse, Rural Health and Underserved Populations
As the demographics of the United States are rapidly changing, health disparities are increasing and need to be rectified. Healthcare needs must be met without the disparities that cause poor health, suffering, and an economic drain. Although considerable progress in expanding healthcare services and quality of care has been made, racial and ethnic disparities still exist. The causes of these disparities are complex and include system, patient, and provider factors.
The challenges of the provider in this diverse population can be overwhelming, especially when trying to work within a system that may value productivity and cost control rather than quality and outcomes. APNs have a duty to serve patients' best interests not the interests of the system. They must recognize and understand cultural differences and value and respect people of different cultures while treating them with respect.
Understanding, communication, and trust produce the best outcomes and will help to reduce health disparities. APNs have the challenge but also the opportunities to have a major impact on the health care disparities in the United States by being culturally aware researchers, advocates, educators, and providers to the diverse population.