Barriers to Healthcare

A gap in care can be defined as the discrepancy between the recommended best practices and the care offered. Such gaps can manifest in people who are missing annual vaccines or screenings and who fail to consult their doctors about overprescribed medication that could be inappropriate for the patient. Identifying care gaps is considered the most challenging part of closing such care gaps (Springbuk, 2020). Health systems work to develop efficient, integrated approaches that can be used to deliver care that increases value for patients. Gap identification is the first step to closing such gaps.

One commonly used way of identifying gaps is face-to-face contact, which is said to outrank mobile applications, surveys, social media, and patient portals (Finocchiaro, 2017). This method involves asking patients directly regarding issues such as the last time they had their mammogram and vaccines, among other things. Using this tool could be cumbersome to the healthcare givers given their workload and the pressure put on them to ensure quality services are delivered to patients. As a result, technology plays an important role in identifying and filling care gaps.

The use of technology can help streamline data collection as well as the identification of care gaps. A patient-reported data tool is one of the technologies that identify gaps in care. Such a tool can be integrated into the patient portal and the electronic health records. This technology allows patients to be asked important questions, which can help close care gaps and generate a patient chart using patient-reported data (Heath, 2020). This tool can identify gaps by sending emails and messages to patients, prompting them to check their patient portal messages. Once the patient logs in, they can be asked to answer questions such as when they received a flu shot or pneumonia vaccine. This tool is linked to reduced clinician workflow and facilitates a closer relationship between medical practitioners and patients. Given that the data is usually collected outside office hours, caregivers can spend more time and pay attention to the patient, increasing patient satisfaction.

According to Healthy People 2020 (2020), some common barriers to healthcare services include high cost of care, unavailability of services, inadequate or lack of insurance coverage, and lack of culturally competent care. These barriers will likely cause delays in obtaining appropriate care, unmet health needs, preventable hospitalizations, financial burdens, and an inability to obtain preventive services (Healthy People 2020, 2020). Such barriers could be identified with the help of a screening tool. The barrier that I would like to address is the lack of or inadequate insurance coverage.

Health insurance coverage is important because it enables patients to gain access to the healthcare system. Lack of or inadequate coverage makes it hard for individuals to obtain the kind of healthcare needed, and when they do obtain such care, there are major medical bill burdens. Research shows that uninsured people are more likely than insured people to have poor health status, reduced likelihood of obtaining medical care, dying prematurely, and being diagnosed later (Healthy People 2020, 2020; Fan et al., 2019). If I could develop a screening tool to address the lack of or inadequate insurance in healthcare, then the tool would be based on a financial assessment.

Poor people are more likely than others to lack or have inadequate insurance coverage. Furthermore, poverty places individuals at an increased risk of chronic diseases like diabetes which are costly to treat, especially if the bills are taken out of pocket. The tool would involve important questions like “Do you have difficulties making ends meet or paying bills at the end of the month? Do you have any chronic diseases? How do you pay for your medication and healthcare costs? How often do you seek health services when sick? Do you have any form of insurance? Is there anyone in your family who has insurance coverage?” Do you have any form of employment? Does your work provide any form of insurance?” The tool will be used to assess the financial situation of the patient and understand the different struggles that they experience. The tool will also ask questions regarding the race and ethnicity of the clients to make comparisons based on these aspects to find out the number of people from particular backgrounds who still lack insurance coverage. Generally, research shows that Blacks and Hispanics are 1.5 times and 2.5 times more likely to be uninsured than Whites, respectively (Artiga & Orgera, 2020). This tool can be generated and filled out through online surveys or verbal communication. Andermann (2018) outlines the importance of screening tools, claiming that such tools can help increase coordination and shared responsibility with agencies and support centers that can help patients with certain barriers to accessing healthcare services.

This screening tool will be administered by frontline health workers such as nurses, community health workers, and doctors or physicians. These are the individuals who have first-hand experience with patients. They are the link to essential health services for most people, providing lifesaving treatment and care. Frontline health workers are also key in preventing and treating non-communicable chronic diseases like heart disease and diabetes, which increasingly and disproportionately affect people with low incomes. Chapel et al. (2017) claim that the economic and health burden of non-communicable chronic diseases among Medicaid beneficiaries is very high. Such costs are even higher for those without insurance.

This problem can be solved through increased financial resources, time, and healthcare workers. To encourage increased utilization of the screening tool, it will be important to use incentives and bonuses among healthcare workers. Such incentives will come in the form of a small token of appreciation for every healthcare worker who can make a successful referral for a patient to enable them to obtain the required insurance coverage. Therefore, the healthcare facility will be required to allocate more financial resources toward this course. Another resource that will be employed is more time. More time will be needed with patients to make it possible for them to answer the questions in the screening tool. This would require a caregiver to take more time with a patient, trying to gauge their issues and finding ways of helping them. However, with the probability of a high workload, technology can be employed to help streamline workflow and reduce the time spent on a patient. For instance, the screening tool can be available online, and a patient should be required to fill in these questions before treatment. This will apply to individuals who are not critically ill. Once such information has been filled in, it will be easier for the caregivers to assess any barriers to obtaining healthcare services. Lastly, more healthcare workers will be needed to be able to assess every patient and avoid burnout as well as excessive workload. A nursing informaticist can be employed to help with the collection and analysis of data.

This screening tool will be feasible for a clinical setting. There is growing interest among frontline health workers, especially those working in sections like caring for people without homes and marginally housed individuals, as well as immigrant and refugee health, to be more equipped with evidence-based guidance on ways of offering better care and support to such individuals in their clinical practice (Andermann, 2018). Screening for individuals who lack or have inadequate insurance coverage will make it possible for healthcare workers to increase healthcare accessibility to individuals in the community.

This screening tool is also easy to use and requires minimal training for healthcare workers. The care workers will only need training on identifying patients in need of aid and how to ask questions to get the patients to open up. The purpose of doing so is to provide holistic care, lessen the probability of patients experiencing poor health outcomes due to lack of insurance coverage, and make healthcare more accessible and affordable to individuals of all backgrounds. In a clinical setting, it is possible to employ the necessary resources, such as frontline healthcare workers in close relations with individuals in the community. In particular, community workers can provide comprehensive details regarding individuals in need of financial assistance and make it possible for such individuals to obtain quality care after they obtain sufficient insurance coverage.

References

Andermann, A. (2018). Screening for social determinants of health in clinical care: moving from the margins to the mainstream. Public Health Reviews, 39(1), 1-17.

Artiga, S.,& Orgera, K. (2020, March 5). Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018. Kaiser Family Foundation. Retrieved from https://www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/

Chapel, J. M., Ritchey, M. D., Zhang, D., & Wang, G. (2017). Prevalence and medical costs of chronic diseases among adult Medicaid beneficiaries. American journal of preventive medicine, 53(6), S143-S154.

Fan, H., Yan, Q., Coyte, P. C., & Yu, W. (2019). Does public health insurance coverage lead to better health outcomes? Evidence from Chinese adults. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 56, 1-10.

Finocchiaro, P. (2017, January 8). Five ways to close gaps in care and build a successful quality improvement program. Managed Healthcare. Retrieved from https://www.managedhealthcareexecutive.com/view/five-ways-close-gaps-care-and-build-successful-quality-improvement-program

Healthy People 2020. (2020). Access to Health Services. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

Heath. (2020). Using Patient-Reported Data to Detect, and Address Care Gaps. Patient Engagement Hit. Retrieved from https://patientengagementhit.com/news/using-patient-reported-data-to-detect-address-care-gaps

Springbuk. (2020). What is a Gap in Care? Retrieved from https://www.springbuk.com/resources/blog/what-is-gap-in-care

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