Research Problem
Uninsured patients with bipolar disorder and other mental illnesses have limited access to healthcare services because diagnosis, treatment, and management of the disorder are very expensive. Bipolar disorder is a lifetime disorder that requires early diagnosis and appropriate treatment for effective management to reduce mortality rates and increase the lifespan of the patients. According to the National Institute of Mental Health (2009), bipolar disorder is the most expensive mental illness to both patients and health insurance companies because lifetime medical costs per patient range from $11,000 to $600,000 depending on the severity of the disorder (p.7). The lifetime medical costs are very high in that, only insured patients can afford and access necessary treatment and management measures from the healthcare system. Since uninsured patients can neither afford nor access recommended treatment and management measures in the healthcare subsystem, they tend to have high mortality rates that reduce their lifespan. In view of this, the research proposal seeks to establish if significant differences exist in healthcare services that insured and uninsured patients of bipolar receive. Moreover, the research proposal seeks to explore potential justice and social ramifications associated with healthcare disparity between insured and uninsured bipolar patients.
Given that bipolar disorder is a long-term illness that requires proper management, it is imperative that uninsured people receive equal medical services like their counterparts who are insured. It is discriminative for the healthcare system to concentrate on offering better services to insured patients of bipolar leaving other patients uninsured. Seltzer (2007) argues that the existence of disparities in the healthcare system hinges on the fact that physical and mental illness are separate entities that receive funds and experts from different sources (p.1). While healthcare services of physical illness receive effective funding and are accessible to patients, healthcare services that relate to mental illness receive ineffective funding and are hardly accessible to patients with bipolar disorder, particularly uninsured ones who depend on government support. It implies that disparities exist in the healthcare system regarding the delivery of medical services, which involves physical and mental illness. Therefore, the research is going to explore and analyze disparities in healthcare services regarding mental illnesses, especially bipolar disorder and provide the basis of formulating policies to ensure that healthcare services are equitable, accessible, and affordable to all patients with mental illnesses.
The disparity in healthcare services in terms of physical and mental illnesses, as well as insured and uninsured patients, significantly affect treatment and management of the bipolar disorder in any given population. Differential treatment and management of mental disorders and physical illnesses have greatly changed the social perception of diseases. While social perceptions seem to empathize with physical illnesses, they denigrate mental illnesses thus putting more strain on bipolar patients, caregivers, and their families. Such stigma isolates bipolar patients from receiving proper treatment and management of their condition. National Institute of Mental Health (2009) states that inadequate treatment and management of bipolar disorder have great social ramifications because it can lead to increased abuse of drugs, instability in families, reduced functional status of patients and extended burden to families and caregivers, which is quite stressful (p.22). The great social ramifications warrant changes in policies to ensure that uninsured bipolar patients have equal access to healthcare services as their insured counterparts thus enhancing social equity in the healthcare system. Moreover, poor treatment and management of bipolar disorder due to unaffordable and inaccessible medical services have legal implications, as there will be increased cases of drug abuse, suicidal incidences, and criminal activities arising from manic episodes of the disorder.
Literature Review
Bipolar disorder is a psychological disorder characterized by intermittent moods and energy levels thus affecting the ability of a patient to function normally. The disorder affects neurons in the brain, hence causing uncoordinated functions of the same. The functions of the brain depend on the intermittent moods of depression and mania that characterize the disorder. Variability in manic-depression moods affects the cognitive ability of an individual, elicits fears, distorts rational thoughts, causes great trauma, and development of suicidal feelings. The disorder mostly affects adults, while some cases occur in children due to the heritable nature of the disorder. According to the National Institute of Mental Health (2009), bipolar disorder ranks sixth as one of the causes of disability across the world and prevalence studies carried out by the American Psychiatric Association show that approximately 1.5% of American adults suffer from bipolar disorder (p.17). With the disparity in delivery, affordability, and accessibility of healthcare services related to bipolar disorder, trends are likely to worsen due to poor treatment and management measures that uninsured patients with bipolar receives.
Proper diagnosis, treatment, and management of mental disorders are very critical aspects of healthcare services that need urgent attention so that uninsured patients can afford and access medical services. The uninsured patients are not only receiving limited medical services from the healthcare system, but also inconvenient services that do not save their lives in cases of emergency. Studies have shown that separation of physical and mental illness in the healthcare system is to blame for poor treatment and management of mental disorders, particularly bipolar disorder. Initially, separation of physical and mental illnesses was meant to increase efficiency in healthcare delivery due to the specialization of medical experts, but it has resulted in immense discrimination against mental illnesses. Consequently, patients with mental illnesses have received poor attention not only from government funding but also from healthcare systems causing a tremendous increase in their mortality rates that reduce lifespan. Seltzer (2007) argues that patients with mental illnesses such as bipolar disorder, schizophrenia, and other mental conditions are prone to die 25 years earlier as compared to the general population (p.1). Therefore, if appropriate measures are not put in place to ensure that uninsured bipolar patients receive affordable, accessible, and equitable medical care, it means that their mortality rates will continue to increase and their lifespan will decrease abnormally.
Despite great efforts by the healthcare system to improve mental health across the United States, rural areas inhabited by the poor still experience high cases of mental disorders including bipolar disorder. Given that uninsured bipolar patients are mainly the poor who cannot afford to subscribe to medical insurance, they live in rural areas where healthcare services are not only inaccessible but also unaffordable. Since mental illnesses demand a great deal, of medical services given that, they are hard to cure and expensive to manage throughout the lifespan of a patient, the uninsured patients of bipolar suffer greatly. According to a study by Gustafson, Preston, and Hudson (2009), over 50% of calls emanating from rural areas report mental cases of sicknesses and high rates of suicides as compared to urban areas in spite of the similarity of mental disorders (p.2). Hence, the disparity in cases of medical needs and suicides clearly portrays that uninsured bipolar patients have limited access to health resources as compared to their insured counterparts. Lack of medical insurance or insufficient money limits bipolar patients from accessing recommended treatment and management measures of the disorder. As aforementioned, the cost of treating and managing bipolar disorder ranges from $11,000 to $600,000 depending on the severity of the disorder; that is, whether acute or chronic. This means that affordability and accessibility are very important in addressing bipolar disorder in uninsured patients.
Bipolar patients also experience challenges in becoming eligible to Medicare for federal law bureaucracy stipulates that they have to wait for a period of two years for medical insurance to take effect after receiving Social Security Disability Insurance, which certifies their mental disability. Since the bipolar disease progresses gradually, a period of two years without appropriate treatment or management intervention is too long for a patient to retain a good health condition. Various studies have shown that proper prevention, treatment, and management of bipolar disorder need early diagnosis and timely curative measures. In this instance, a period of two years waiting for the medical cover to take effect has detrimental effects on the lives of patients with bipolar disorder. William, Dulio, and Claypool (2004) argue that waiting for a period of two years for Medicare insurance to take effect poses great difficulties to the uninsured patients since they continue suffering irrevocably; consequently, they receive irregular healthcare services that are insufficient and place extra burden on their families and dependents (p.8). Such bureaucracy in federal law inhibits timely accessibility of healthcare services by patients with bipolar disorder who are uninsured and therefore limits the accessibility of healthcare resources in the treatment and management of mental disabilities.
Research studies have also found out that limited access to healthcare services and the high cost of treating and managing bipolar disorders have a great impact on the social and justice aspects of society. In terms of social aspects, the least attention offered to mental illnesses by the healthcare system and government through funding casts a perception that degrades treatment and management of bipolar disorder. Moreover, coupled with complexity and beliefs regarding mental illnesses, the bipolar condition becomes one big misconception and stigmatization as people see it as a curse or unmanageable condition that directly translates to death. Social stigma enhances the progress of bipolar disorder for it increases stress and depression of bipolar patients, which consequently adds more burdens to caregivers and families since they have no insurance cover to alleviate their medical costs. Lane and Stobo (2008) argue that uninsured patients access minimal preventive care, get a diagnosis of their condition late, and receive insufficient therapeutic care as compared to their insured counterparts (p.48). This implies that uninsured patients with bipolar disorder cannot access required medical services and will die prematurely. In a legal aspect, since bipolar patients are prone to commit crimes when in a manic episode, the inability to access healthcare services predisposes them to abuse drugs, commit suicide and even kill others.
Bipolar disorder predisposes one to commit suicide because depressive episode elicits suicidal feelings in bipolar patients that compel them to commit suicide. Studies have revealed that over 60% of suicides are due to depression. This implies that depressive episode of bipolar disorder contributes significantly to high rates of suicide among patients with mental illnesses. Walter (2007) explains that, out of about 2 million Americans who are suffering from bipolar disorder, approximately 3-20% commit suicide (p.6). Given that there are numerous causes of depression that predispose people to commit suicide, bipolar disorder is one of the causes that contributes significantly to increasing cases of suicide among patients with mental illness.
Objectivity, Ethics, and Sampling
The objective of the research proposal is to establish if a significant difference exists in inaccessibility to healthcare resources by both insured and uninsured bipolar patients. The research findings will be critical in the formulation and implementation of policies geared at enhancing equity, affordability, and accessibility of healthcare services. Prior to the research, l had assumed that the healthcare system and insurance policies provide equal medical services to all diseases; however, during the course of the research, I realized that great disparity exists between mental illnesses and physical illnesses. Moreover, the nature of medical services depends on whether one is insured or uninsured. The assumption that healthcare and insurance companies offer equal medical services to all patients may underestimate the findings of the research and thus need critical analysis. To avoid imposing bias emanating from assumption, I will carry out a survey that employs a standard questionnaire rather than an interview, which is prone to bias.
The research proposal has no significant ethical concerns since it does not delve deeper into sensitive and confidential information that relates to patients’ conditions. Therefore, the research does no harm to the patients either during the process of carrying out research or during the implementation of the findings. The research proposal deals with bipolar patients and aims at deriving relevant information regarding diagnosis, treatment, and management of bipolar disorder. Although the research has no significant ethical consideration, the patients may have reservations concerning the necessity of the information and its importance to them. For instance, patients may find it hard to reveal information regarding drug abuse, suicidal attempts, and crimes they have committed. In this case, briefing the patients on the essence and importance of the research helps in allaying fears that emanate from such research questions, and enhancing the completion of questionnaires properly. To improve participation and compliance of the patients in filling questionnaires, therapists should brief and preview samples of questionnaires to the patients during the consultation to dispel unnecessary ethical misconceptions that may impair the collection of the information through questionnaires. Ultimately, patients need assurance that the information collected from them will be in the safe and confidential hands of the researchers and will exclusively be applicable to the purposes of the research.
Healthcare institutions that offer services of mental illness will provide catchment for patients with bipolar disorder. The target population of the research is bipolar disorder patients who obtain their medical services at selected healthcare institutions across the nation. Thus, the sampling frame of the research consists of various healthcare institutions or departments within the healthcare system that deals with mental illnesses, especially bipolar disorder. Unit of the analysis entails insured and uninsured bipolar disorder patients for comparative studies to establish whether there is any significant difference in utilizing healthcare resources. Since the population of patients with bipolar disorder is negligible as compared to the entire population, the use of non-probability sampling technique of availability sampling or convenience sampling is quite appropriate. Availability sampling is a non-probability sampling technique that entails a haphazard selection of subjects that are readily available, and it involves a single stage of administering and collecting questionnaires for statistical analysis. According to Marshall (1996), convenience sampling is very reliable because it has no research bias since there is a haphazard selection of subjects (p.523). Moreover, the method is advantageous as compared to other methods because it is simple, easy, and effective in carrying out surveys in a specific population of subjects.
Research Methodology
The researchers will employ closed questionnaires when collecting relevant information for the research. Collection of data will entail the use of self-administered questionnaires distributed to patients after briefing and acquaintance with research objectives. Since the subjects of the study are patients with bipolar disorder, researchers will administer questionnaires to them at their respective healthcare institutions where they seek medical services. The researchers will teach the patients how to complete the questionnaires, give them questionnaires to complete, and provided them with enough time that is sufficient for the successful completion of the questionnaire in a sitting. Convenience sampling or availability sampling is therefore the most appropriate method of sampling patients because they are very few. The following is a sample of closed questionnaires for the research.
- What is your age?
- What is your gender?
- When were you diagnosed with bipolar disorder?
- Are you an insured or uninsured patient?
- Is there any unfavorable bureaucracy that affects subscription to medical insurance?
- How often do you access medical services per month?
- Have you ever lacked medical services due to inaccessibility?
- Have you ever lacked medical services due to unaffordability?
- According to your opinion, do you think you are receiving optimum healthcare services?
- Are there any changes that you think the healthcare system should make to accommodate people with bipolar disorder and other mental disorders?
- Do you feel any social stigma from caregivers, family members or the entire society?
- Have you ever developed any suicidal feelings?
- How many suicidal attempts have you tried?
- Do you abuse any drugs?
- Have you ever committed any crime?
Research Schedule
To carry out effective and comprehensive research, the researchers will conduct reconnaissance and pilot studies at selected healthcare institutions that deal with bipolar patients and liaise with therapists in the formulation of the research schedule. The reconnaissance and pilot study will provide a basis for designing an effective research program aimed at deriving relevant information from the patients through questionnaires. Since the research aims at establishing if a significant difference exists in healthcare services that insured and uninsured patients of bipolar disorder receive from the healthcare system, variables that relate to diagnosis, treatment, and management of the disorder are critical. Reconnaissance will acquaint the researchers, patients and therapists with the nature of research and dispel any reservations that may restrain the informed consent of the patients. The pilot study intends to offer a preview of the research to patients, therapists and researchers with the view of avoiding unnecessary mistakes when filling questionnaires for they can potentially invalidate research findings.
Main research will take a period of two months where researchers will be administering questionnaires to patients with bipolar disorder who are seeking medical services at selected healthcare institutions during this period. The research schedule needs a period of two months for successful completion of the research because patients of bipolar are not only very few but also rarely seek medical services. Bolton (2006) asserts that the use of the conventional method of sampling over a relatively long period not only enhances external validity but also internal validity of the research findings (p.3). Therefore, a period of two months is enough to get a significant number of patients with bipolar disorder and thus enhance external validity as well as the extrapolation of the research findings. During the period of two months, researchers will administer questionnaires using the sampling method of convenience and guide the patients in the successful completion of questionnaires. Researchers will also make a daily compilation of the research data and conduct weekly analysis of the data to ascertain if any consistency or variability exists.
References
Bolton, W. (2006). Internal and External Validity. Journal of Statistical Analysis, 5(9), 1-19.
Gustafson, D., Preston, K., & Hudson, J. (2009). Mental Health: Overlooked and Disregarded in Rural America. Center for Rural Affairs, 4, 1-5.
Lane, N., & Stobo, J., (2008). Consequences of the Uninsured and Underinsured. Code Red, 12, 46-63.
Marshall, M. (1996). Sampling for Qualitative Research. International Journal of Family Practice, 13(6), 522-525.
National Institute of Mental Health, (2009). Bipolar Disorder. National Institute of Health, 1-31.
Seltzer, T. (2007). An Avoidable Tragedy: The Relationship of Premature Death and Serious Mental Illness. The National Council for Community Behavioral Healthcare, 1-7.
Walter, D. (2007). National Statistics from the American Foundation for Suicide Prevention. Food and Drug Administration, 16, 1-12.
William, B., Dulio, A., & Claypool, H., (2004). Waiting for Medicare: Experiences of Uninsured People with Disabilities in the Two-Year Waiting Period for Medicare. Christopher Reeve Paralysis Foundation, 1-38.