Homeless Population and US Healthcare Models

A vulnerable group or population is characterized by people who are economically disadvantaged, an ethnic minority, low-income earners, the elderly, racial minorities, those with HIV or those with chronic conditions of health, which may involve mental illness (Mechanic & Tanner, 2007). This group may also comprise of people living in the rural regions with limited access to social amenities like healthcare. Vulnerability may be enhanced by age, ethnicity, and sex. Other factors may include lack of insurance cover, income, and the unavailability of routine care. However, other additional factors like poverty, inadequate education, and housing intersect with their health and healthcare.

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The case study for this vulnerable population group is the homeless population in the U.S. The homeless population has been a primary concern for policy formulators and the society as a whole. According to the Department of Housing and Urban Development in the US point-in-time count, 633,782 people were found to be homeless as at January 2015 (National Alliance to End Homelessness, 2015). Further, in a recent estimate, unduplicated people in the US were found to be about 1.6 million. This group was also found to use emergency shelters or houses that were mostly transitional. Notably, there has been a nine percent increase in homelessness in the United States of America since the year 2007 because 1/3 of these people have children and households (National Alliance to End Homelessness, 2015). According to the National Law Centre on issues regarding the homeless and the poor, the homeless population stands at about 3.5 million, with children accounting for 1.35 million of the total homeless persons. Eventually, these children are likely to end up becoming homeless parents when they grow up (National Alliance to End Homelessness, 2015).

Application of the Vulnerable Population Conceptual Model

Resource Availability

Some structural factors that make up both socioeconomic and environment risk factors contribute to homelessness. The factors include minimal income levels and limited access to health and affordable housing. One of the issues that contribute to these two states is limited jobs following the economic depression (Shelton, Taylor, Bonner, & van den Bree, 2015). Thus, most people are not able to get sustainable jobs that allow them to meet their needs. Notably, the poor are just a step away from being homeless if they fall ill.

Second is the closure of long-stay psychiatric hospitals. Most of the people that are admitted to psychiatric clinics and hospitals are homeless by nature. However, the system has failed to devise a suitable discharge environment that ensures such people can get aftercare upon their release from the facilities (Shelton et al., 2015). Thus, most of the people return to the streets.

Relative Risks

Some of the most common risk factors for homelessness are substance abuse and mental illness. The use of illicit drugs and depression are highly prevalent among the homeless people. About 33 percent of the homeless persons have mental illness.

Poor relationships are also risk factors. The primary factor for homelessness is the dissolution of key relationships that would help in leading an ordinary life. Marital breakdown or erosion of personal relationships may limit one’s economic state and their ability to get good housing. It is estimated that women suffer most from divorces. Notably, most women’s economic state dwindles by 40% after they are divorced (Echenberg & Jensen, 2009).

Other risk factors for homelessness are affordability and income of the affected persons. One of the key problems that homeless people face is that they cannot get affordable housing to match the minimal level of income they earn. One research has shown that the cost of housing has accelerated over the level of revenue growth. The study identified that median tenants between 1997 and 2005 spent an additional 21% on housing, even though their income levels had only increased by 12% (Echenberg & Jensen, 2009). Genetically, African Americans are most likely to end up homeless as they contribute the largest population of homeless people, i.e. 42% (Echenberg & Jensen, 2009).

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Health Status

Homeless people are exposed to poor health conditions compared to the general population. Some of the main health challenges that this population face are high psychiatric disorders and heightened mortality rates due to substance abuse. Further, homeless populations have higher morbidity rate as being homeless is an independent causative agent of high mortality ratios arising from drug use, respiratory, and circulatory diseases. Moreover, there are variations in mortality rates among the homeless people, with whites facing higher mortality rates compared to other races. Further, older women seem more likely to survive in such situations compared to their aged male counterparts, even though younger females appear to be less resilient to such conditions (Echenberg & Jensen, 2009).

Comparing the Four Health Care Models

The Beveridge Model

The government is the primary provider of funds and health services in the Beveridge model of care. Here, the government has full control of the system, including what doctors are expected to do and making healthcare affordable because it is the sole financier (Kulesher & Forrestal, 2014). The model is implemented in Scandinavian nations, in addition to countries like Spain and New Zealand, among others. The Beveridge model is also implement in Hong Kong, having taken up the model from their colonial masters. This happened in the year 1997. The country that represents the world’s purest example of this model is Cuba (Wallace, 2013).

The Bismarck Model

The Americans would still find this model familiar because it has a European heritage. The employers and employees are normally the ones who finance the sickness funds through deduction from the payroll (Wallace, 2013). This plan is for covering all the citizens. Moreover, the providers do not make any profit, unlike the practice in the U.S. It is imperative to note that unlike the US, Japan has more private hospitals and doctors. In Germany, there are about 240 funds (Wallace, 2013). The German government imposes tight regulations and has more control on costs, despite the fact that the single-payer Beveridge model is in place.

The National Health Insurance Model

The national model encompasses the Bismarck and Beveridge plans. The payment for this system comes from the government, being that every citizen of the country is forced to contribute to the fund, even though most of the service providers are people from the private sector (Kulesher & Forrestal, 2014).

Out of the Pocket Model

Last is the out of pocket model, where the wealthy can afford medical care while the poor languish in sickness as they cannot afford the services. In this kind of system, it is not possible for the government to provide mass care for the citizens (Wallace, 2013). The poor may access the services through contracting the local medicine men and healers.

For most of the American people, the ability to get healthcare is tied to employment. Thus, most persons working as employees for a given company can enjoy such benefits as they are voluntarily covered by their employers. However, the future of healthcare would be dim, given that most of the working age persons are not able to obtain jobs. In fact, employers are dropping employees because of the inability to afford the workers’ health care insurance costs. Thus, there is a possibility that the vulnerable populations may never get to a point of affording quality health care.

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