Introduction
There is a variety of problems and risks patients may encounter when receiving care. For the purpose of the current paper, the focus on the issue of access to care among vulnerable populations was selected. The purpose of this assignment is to review relevant literature that addresses the problem of gaps in access to health care among vulnerable populations of different characteristics, such as racial and cultural qualities and sexual orientation, in various care settings.
This problem is critical to discuss since inequity in access to affordable and high-quality care contributes to the decrease of health within vulnerable populations and creates further challenges for the healthcare industry as a whole. The question to be explored in the review is: “Are there gaps in access to health care among vulnerable populations within different clinical settings?” The review of the literature does not focus on one specific population or a certain healthcare setting to provide the explanation of the existence of gaps in access to care on multiple levels.
Methods
The main method of searching for relevant literature implied the use of online library nursing databases such as PubMed, Cochrane, ERIC, and Nursing Reference Center. Qualitative, quantitative, mixed-methods studies and systematic reviews were included in search criteria. Keywords used in the inquiry included “care access,” “health care access disparities,” “minorities and health care,” and “care access inequality among minorities.” It was chosen to review ten journal articles published between 2013 and 2018.
Statistical Data
According to the report prepared by National Center for Health Statistics (2016), there exist considerable divergences in health care access between different population groups. For instance, in 2014, 8.2% of individuals admitted not being able to receive timely medical care because they could not afford it (National Center for Health Statistics, 2016). Also, 5.6% of people reported the impossibility to pay for the medicines prescribed to them. Another issue was that 10% of citizens could not receive the appropriate dental care due to the lack of money (National Center for Health Statistics, 2016). These figures vary from year to year, but the general message remains the same: there are many people living in the US that cannot afford the health care they need. However, it is not only poor population groups that cannot use medical care to the full extent. Racial, ethnic, and sexual disparities also present a serious barrier for many people looking for medical support.
The Analysis of Literature
Racial and Ethnic Disparities
The articles selected for the analysis examine the effect of disparities on health care access. The majority of sources is focused on racial and ethnic differences (Chen, Vargas-Bustamante, Mortensen, & Ortega, 2016; Cook, Barry, & Busch, 2013; Fiscella & Sanders, 2016; Flores & Lin, 2013; Shi, Chen, Nie, Zhu, & Hu, 2014). The study conducted by Chen et al. (2016) aims at examining “racial and ethnic disparities in health care access and utilization” after the full implementation of the Affordable Care Act (ACA) in 2014 (p. 140). Researchers state that the minorities that have historically encountered disparities in access and coverage of care have improved their data under the ACA in comparison to whites (Chen et al., 2016). However, other sources indicate that these data are not so optimistic as they might sound.
Research by Flores and Lin (2013), focused on the analysis of trends in racial and ethnic differences in US children’s access to care, offers the following statistics. In the period between 2003 and 2007, as many as ten new disparities in health access appeared, and two have worsened (Flores & Lin, 2013). While researchers note that fifteen gaps have decreased during the investigated period, the rise of new ones means that the situation is still unsatisfactory.
Another study focused on children’s health care access disparities is the one by Cook et al. (2013). Scholars analyze children’s mental health care access in approximately the same period as Flores and Lin (2013): from 2002 to 2007. Cook et al. (2013) conclude that there are considerable disparities for Latino and black children in access to mental health care, psychotropic drug use, and outpatient care. According to the authors, many of these young patients do not receive the necessary care due to the unwillingness of medical personnel to initiate treatment.
Shi et al. (2014) study socioeconomic and racial disparities in accessing primary care among patients diagnosed with chronic conditions. Scholars note that there are significant racial disparities in such categories as a usual source of care, types of providers for usual sources of care, and location of the usual source of care. On the other hand, Shi et al. (2014) do not report any disparities in the ease of contacting healthcare providers or getting to patients’ source of care as well as services that they need to access.
Fiscella and Sanders (2016) also analyze the disparities in the quality of care for racial and ethnic minorities. Scholars conclude that the gap usually results from complex relationships between patient-specific factors and industry-related factors. As well as Flores and Lin (2013), Fiscella and Sanders (2016) consider that the progress in elevating such disparities is too slow.
Other Crucial Disparities
Immigrants and refugees
The problems of this vulnerable population group are investigated by Avila and Bramlett (2013) and Mirza et al. (2014). Both sources are focused on the problems of accommodation to the new environment and the difficulties related to health care access as the result of considerable life changes. Also, both articles identify the major problems for immigrants and refugees and suggest solutions to them.
Avila and Bramlett (2013) remark that the language used in the household has a crucial impact on children’s immigrant status. The sooner they learn English, the better their chances to be accepted in society and receive proper health care will be (Avila & Bramlett, 2013). The same conclusion is made by Mirza et al. (2014) who identify language and communication barriers as the greatest problems for immigrant populations.
Sexual minority groups and workforce diversity
Findings of a systematic review conducted by Mitchell, Lee, Gren, and Skyes (2016) report that the lack of nurses’ education on LGBT awareness is the primary barrier to this minority population’s access to high-quality care. Also, scholars remark that this group of individuals is not treated with respect and attention. Mitchell et al. (2016) emphasize that nurses are not prepared to speak about disparities and health care concerns of the LGBT community because they are not offered any education on this issue.
To address the problem of the lack of such education for nurses, Jackson and Gracia (2014) and Williams et al. (2014) investigate the role of a diverse workforce and social determinants of health. Researchers suggest such solutions as promoting cultural competency training and community health workforce models. Jackson and Gracia (2014) and Williams et al. (2014) consider these suggestions as important steps that could ensure equality in access to care among ethnic and racial minorities.
Discussion
Racial, ethnic, and social disparities in access to health care have been extensively studied since the mentioned characteristics often coincide with populations’ inability to receive high-quality care. The review of relevant research literature shows that there are gaps in access to health care among vulnerable populations within different clinical settings. Further research is needed for finding and evaluating appropriate solutions and strategies to overcome disparities and providing minorities with a high level of care to improve their health outcomes. Increased attention should be paid to the needs of such minority communities as LGBT people who have suffered from the lack of understanding on the part of nurses.
Conclusion
The data obtained from the analyzed sources is highly relevant to the question of gaps in access to health care. The articles were grouped by the subject of investigation, which allowed comparing, contrasting, and connecting the findings they offered. Many scholars focus their investigations on racial and ethnic disparities in health care access. Some studies are dedicated to the analysis of workforce diversity and sexual minorities’ problems in receiving health care. The synthesis and analysis of these sources allow making a conclusion that disparities in health care access present a crucial problem in modern society. It is necessary to find solutions to this issue in order to give all citizens equal options of treatment and encourage individuals to address healthcare facilities without the fear of being stigmatized or misunderstood.
References
Avila, A. M., & Bramlett, M. D. (2013). Language and immigrant status effects on disparities in Hispanic children’s health status and access to health care. Maternal and Child Health Journal, 17(3), 415-423.
Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical Care, 54(2), 140-146.
Cook, B. L., Barry, C. L., & Busch, S. H. (2013). Racial/ethnic disparity trends in children’s mental health care access and expenditures from 2002 to 2007. Health Services Research, 48(1), 129-149.
Fiscella, K., & Sanders, M. (2016). Racial and ethnic disparities in the quality of health care. Annual Review of Public Health, 37, 375-394.
Flores, G., & Lin, H. (2013). Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: Has anything changed over the years? International Journal for Equity in Health, 12(1), 10.
Jackson, C. S., & Gracia, J. N. (2014). Addressing health and health-care disparities: The role of a diverse workforce and the social determinants of health. Public Health Reports, 129(2), 57-61.
Mirza, M., Luna, R., Mathews, B., Hasnain, R., Hebert, E., Niebauer, A., … Mishra, U. D. (2014). Barriers to healthcare access among refugees with disabilities and chronic health conditions resettled in the US Midwest. Journal of Immigrant and Minority Health, 16(4), 733-742.
Mitchell, K., Lee, L., Green, A., & Skyes, J. (2016). The gaps in health care of the LGBT community: Perspectives of nursing students and faculty. Interdisciplinary Journal of Undergraduate Research, 5(5), 21-30.
National Center for Health Statistics. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD: National Center for Health Statistics.
Shi, L., Chen, C-C., Nie, X., Zhu, J., & Hu, R. (2014). Racial and socioeconomic disparities in access to primary care among people with chronic conditions. JABFM, 27(2), 189-198.
Williams, S. D., Hansen, K., Smithey, M., Burnley, J., Koplitz, M., Koyama, K., … Bakos, A. (2014). Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing. Public Health Reports, 129(Suppl. 2), 32-36.