Posts under ‘healthcare access’

The Obama-Biden Transition Team is requesting that all interested citizens pay a visit to the transition’s website, Change.gov, and voice ideas and concerns regarding American health care and health care reform. By clicking here, you can go directly to the web page dedicated to the health care agenda and submit your opinions and views.

The Obama-Biden web page discusses health care in this manner:

“On health care reform, the American people are too often offered two extremes — government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

“The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

“Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.”

Allegedly, the plan would:

• Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
• Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
• Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
• Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
• Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees’ health care.
• Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
• Ensure everyone who needs it will receive a tax credit for their premiums.
• Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
• Require hospitals to collect and report health care cost and quality data.
• Reduce the costs of catastrophic illnesses for employers and their employees.
• Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

I am personally dubious that insurance company practices can be sufficiently reformed to prevent abuses. I am also dubious that such a ponderous system administered by both the federal government and employers will not prove incredibly complex and difficult to manage for employers, government officials, insurers, providers, and consumers alike.

In terms of the plan, I would also like to see the following:

• details regarding a more robust national plan of preventive health care initiatives
• sufficient funding for public health initiatives
• sufficient funding for emergency preparedness and the national Medical Reserve Corps
• a comprehensive plan to decrease the nursing shortage, including grants and loan forgiveness
• a plan to assuage the nationwide shortage of primary care physicians
• a plan to create an Office of the National Nurse

Despite my reservations, doubts, and dubiousness, it is indeed exciting to see a new administration apparently dedicated to transparency, as well as the active participation of all Americans in the process of change that is underway.

Meanwhile, I am willing to suspend my disbelief, listen to the conversation, join in on the conversation when I have something useful to say, and watch as the story unfolds. These are exciting and nerve-wracking times, and I do indeed hope that the change that has been promised will indeed be delivered. Until that time, patience is one virtue we will all need to put into practice.

(Note: This is my fourth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

The Hispanic population of the United States is growing exponentially, and the Pew Hispanic Center chronicles and tracks the collective successes and challenges of this burgeoning American demographic.

According to the Pew Center, the Hispanic population of the United States—currently the largest minority group in the country—will triple between 2005 and 2050, with non-Hispanic whites poised to themselves become a minority by 2050, certainly the largest projected demographic shift of the 21st century.

Taking these statistics into consideration, it is disturbing to learn that a recent Pew Hispanic Center study reveals that 1 out of 4 Hispanic Americans does not have a regular healthcare provider. Additionally, a similar number of Hispanic respondents reports receiving no medical attention or information from any member of the healthcare system in the previous year.

The Pew study, carried out in partnership with the Robert Wood Johnson Foundation, reveals that “the groups least likely to have a usual health care provider are men, the young, the less educated and those with no health insurance.” The study results also clearly show that Hispanics who are less assimilated into American society—including those who are foreign-born, recent immigrants, and/or those who speak only Spanish—are less likely than their more assimilated counterparts to report having a regular medical provider.

Interestingly, when pressed for reasons why they lack regular healthcare providers, 41% of respondents simply said they lacked a provider because they are rarely sick. And a majority of Hispanic study subjects—83%, in fact—report obtaining the majority of their health information from television. Additionally, 79% states that they are acting on the information obtained from television and other media sources, changing diet and exercise practices solely based on reports and advertisements.

In terms of those Hispanics who have indeed received medical care in the last year, 77% reported their care as “good” or “excellent”. However, 25% of those respondents who received health care over the last five years reports receiving poor treatment within the mainstream American health care system. The report continues by stating, “those who believe that the quality of their medical care was poor attribute it to their financial limitations (31%), their race or ethnicity (29%) or, the way they speak English or their accent (23%)”.

Some other surprising findings also were revealed in the study results:

–45% of Hispanics without a regular health care provider actually have health insurance

–Half of the respondents without a regular provider have at least a high school education

–Many Hispanics without a health care provider were born here in the United States

–60% state that they received health care advice from family and friends in the last year

–A “slight majority” of those without a usual provider are “English-dominant or bilingual”

Following the release of the study, the headlines trumpeted the news: Many Hispanics Shut Out of U.S. Health Care System, Latinos Turn to TV for Health Advice, 25% of Hispanics Don’t Visit Doctor Regularly, among other declarative statements meant to inform the public of the results of the study in simplistic and less-than-nuanced terms.

But what do these findings mean? What do we actually take away from the study results? Is there something in American society—or American health care, in particular—that has to change? With Hispanics carrying a disproportionately significant burden of diabetes and other chronic illnesses when compared to other segments of the population, it is in our best interest as a nation to address these disparities in a meaningful way. Whether we want to believe it or not, a lack of preventive health care on the part of such an enormous demographic will eventually have a widespread economic impact on society as a whole, with everyone eventually paying the price in one form or another.

Considering the climate towards immigrants since 9/11/01, it is this writer’s fear that xenophobic Americans who rely on a “they should all speak English” anthem will use the results of this and other studies to defend their position that immigrants must conform, assimilate, and master the English language as a means to fuller participation and representation within the larger society. While all immigrants do indeed assimilate to some extent as they enter a new culture, the fact that Hispanics will be a majority of the population of the United States in less than 40 years underscores the notion that a broader view of this situation must be taken in order to fully embrace the coming demographic shift and its implications for health and health care in America.

In my work as a nurse care manager for inner city Latinos over the course of the last decade, I have witnessed first-hand how culturally appropriate health care can be delivered to under-served populations despite barriers of language, education, and socioeconomics. However, the Pew/Robert Wood Johnson data suggests that there is more than simple socioeconomic factors which deter Hispanics from seeking regular preventive health care. When extrapolated, the data demonstrates that a large percentage of Hispanics—whether educated, English-speaking, foreign-born or not—have a relative tendency to eschew regular preventive health care, relying instead on the media, a perceived lack of acute or chronic illness, family and friends, and intermittent urgent care, in order to meet their health care needs.

It is my contention that the Pew findings necessitate a great deal of soul-searching for public health officials, Hispanic and Latino consumer groups and community leaders, government officials, as well as a broad spectrum of insurers, regulatory bodies, medical providers, health care systems, and others. I would venture a guess that Hispanic community leaders, clergy, popular entertainers, and other recognized figures of authority and cultural significance would be most likely to succeed vis-a-vis a public relations campaign urging Hispanics to obtain and utilize regular preventive health care. Additionally, it would behoove state and federal governments to invest in such a campaign with the knowledge that pennies invested in preventive health care now will save many dollars in the care of the chronically ill in the future.

So, what might a public relations campaign look like in order to reach Hispanics? Obviously, since such a large percentage of Hispanics report obtaining (and utilizing) health care information from television and radio, I would suggest a massive bilingual ad campaign targeting all segments of the Hispanic community. Highly esteemed popular entertainers and other prominent figures could be recruited as spokespeople for the campaign, providing a familiar and respected face for the project.

Above and beyond spokespeople and television ads, I picture a nationwide body of trained outreach workers (volunteer and othe
rwise), fanning out within their communities, educating their fellow community members about the value of preventive health care. These workers would be armed with literature, contact information for culturally sensitive medical providers accepting new patients, and other resources about what types of preventive health care are most highly recommended. Currently existing outreach infrastructures could be utilized in order to reach deeper into neighborhoods and social circles without duplicating efforts, dove-tailing with other outreach teams already actively involved in their communities.

Just as the gay community pulled together in the early days of the AIDS epidemic, educating one another about prevention and treatment options, stemming the tide of the epidemic, the Hispanic community could, with the appropriate resources, reach out within its own population in an attempt to bring more individuals into the fold. Coupled with a sustained, savvy and intelligent media campaign, major inroads could be made vis-a-vis enrolling Hispanics into primary care.

Considering the breadth of the issue and the potential challenges it presents, many arguments could be made that such a campaign is doomed to failure, and that the economic resources do not exist for such a massive outreach effort. And with no mandate for universal health care in this country, uninsured Hispanics would still be left in the dark. However, if one considers the potential impact of of an aging population of Hispanic citizens in 2050, burdening the economy and the society with undetected and untreated chronic illness, there is no question in my mind that millions of dollars in health care costs would be saved over the course of the next generation.

Preventive health care is an investment, and if we are truly a multicultural and tolerant society of immigrants and the descendants of immigrants, we have an opportunity to show our true colors, embracing the health of our Hispanic brothers and sisters as our own, investing in their—and our—collective future.

The Pew/Robert Wood Johnson study demonstrates what may indeed be a crisis of faith on the part of Hispanic Americans vis-a-vis the mainstream health care system in this country. However, the Chinese symbol for “crisis” is also the symbol for “opportunity”, and this is one opportunity that we as a society should not miss.