Introduction
Even though many people in the US have access to health insurance, there is a significant number who have no coverage and cannot take advantage of that. Therefore, the potential for a crisis, especially for needy families, remains. There is a problem with the high rate of uninsured low-income families in the country. There are numerous reasons why it is so, and one of them is the lack of knowledge on healthcare networks and insurance options. It is healthcare providers, policymakers, and insurance companies that need to improve the US insurance system. The purpose of this report is to consider the problem of the high uninsured rate in the US and propose a possible solution.
The relevance of the topic arises from the fact that there is an increasing number of uninsured people in the US. A particular concern is the high uninsured rate among low-income families and their children. One of the main reasons why they do not have health insurance coverage is that they are poorly informed about the available insurance options and coverage companies. The overarching aim of the research work is to propose a method that can be applied to address the problem of limited information on health insurance services for needy families and children.
Methodologically, the research paper is based on the collection of theoretical and empirical material. The collection of theoretical data is carried out through the method of content analysis. This part of the research addresses reasons for the importance of having health insurance coverage, examines statistical information on current uninsured rates in the US to highlight the existing problem. The empirical part of the research is based on the analysis of the application of a logical model to develop a strategy to contribute to public health and solve the problem of limited access to health insurance for needy families and children in the US.
Literature Review
The research articles of the scientists Ayanian (2009), Tolbert, Orgera, Singer, and Damico (2019), Garfield and Orgera (2020), as well as Berchick, Barnett, and Upton (2019) are the main ones for understanding and analyzing the current state of the health insurance system in the USA. The empirical part is based on the research articles written by Humphreys, et al. (2017) and by Connolly, et al. (2018). These texts describe the structural aspects of a logical model for the development of a strategy to solve the problem of low insured rates in the country among low-income families and their children.
Importance of Health Insurance Coverage
Health insurance covers part of the expenses caused by an insured accident, consultation with a doctor, or other medical services fees through regular joint investment in a common fund. Health insurance coverage is a significant measure of the state’s well-being. Whether it is an illness, injury, or preventative needs, health insurance provides greater access to medical care. It is, first of all, the government and healthcare providers, who have to ensure that a national health insurance system is accessible and open for every social group.
One of the most significant benefits of having health insurance is that in case of any health problem, the insurance companies will pay all the bills. In other words, health insurance coverage offers a cashless facility to its holder. Hospitalization benefits are meaning that an insured person gets admitted into a hospital when it is necessary, and all the medical bills are taken care of by their insurance company. It includes doctor’s fees, room rent, oxygen treatment, blood tests, and others. Moreover, most insurance companies offer plans, which cover the expenses that are occurred during maternity.
The insured one also has the benefit of coverage of some of the costs under the day-care procedures. Also, due to inflation, the cost of healthcare and hospitalization can become expensive and even burden one with debt. Having health insurance coverage allows people to avoid all the adverse effects of inflation because people have already paid for all medical services they may require.
An insured person has numerous advantages compared to an uninsured one. According to Ayanian (2009), “uninsured adults are more likely than insured adults to suffer extremely poor outcomes, including neurological impairment, intracerebral hemorrhage, and death” (p. 3). They are also at higher risk of being diagnosed with advanced cancer and other diseases, such as diabetes, heart attack, hypertension, and others. The researcher also notes that insured children benefit considerably from coverage, first of all, because they are more likely to have access to health specialists and get usual medical care. It should be noted that “they receive the more timely diagnosis of serious health conditions, experience fewer avoidable hospitalizations, have improved asthma outcomes” (Ayanian, 2009, p. 3).
US Uninsured Rates
2018 was a year marked by the first increase in the uninsured rate since the ACA provisions went into effect in 2014 when there were improvements, and people gained access to insurance coverage for the first time. In 2018, according to recent surveys, about 10 percent of the non-elderly population remained uninsured (Tolbert, et al., 2019). According to Tolbert, et al. (2019), in 2018, the number of people who did not have health insurance coverage was 27.9 million people. The researchers note that the number of uninsured American citizens increased by 500 thousand people in 2017 and by 1.2 million people from 2016 (Tolbert, et al., 2019).
It is possible to note that the percentage of people covered by health insurance decreased by 0.5 percent between 2017 and 2018 (Berchick, Barnett, & Upton, 2019). The decrease was primarily driven by a change in public coverage.
Age is associated with the likelihood that a person has health insurance. According to the Census Bureau, in 2018, adults aged 65 and over had the lowest uninsured rate – 0.9 percent. Adults aged 19 to 64 had the low rate, too – around 12 percent (Berchick, Barnett, & Upton, 2019). The uninsured rate increased for adults aged 35 to 44 and 45 to 64, as well as for children aged 0 to 18, between 2017 and 2018. Moreover, researchers note that “the percentage of children without health insurance coverage was significantly higher in 2018 than in 2017” (Berchick, Barnett, & Upton, 2019, p. 9). 5.5 percent or 4.3 million children under 19 years old did not have health insurance (Berchick & Mykyta, 2019). It represented a 0.6 percentage point increase from the previous year.
Problems of the US Health Insurance Coverage System
In 2010, President Baraka Obama signed into law the Affordable Care Act (ACA), also known as Obamacare. The act expanded Medicaid coverage to millions of Americans of all backgrounds. Despite the progress, numerous barriers prevent people from obtaining health insurance. ACA struggles to keep health insurance options and premiums affordable for working and low-income families, stop companies from dropping out of health exchanges and extend coverage to every American. One of the reasons is that there are still many states not adopted the Medicaid expansion decision.
For the year 2020, 37 American states have adopted the expansion, whereas 14 ones have not taken it (“Status of State Medicaid”, 2020). According to Garfield and Orgera (2020), “state decisions not to implement the expansion leave many without an affordable coverage option” (para. 1). Citizens of these states are in the coverage gap and often do not know that they can gain Medicaid eligibility, and therefore they may not try to obtain Medicaid. Moreover, many uninsured people who are eligible for Medicaid are not aware of available health insurance options and companies due to the non-effective means of disseminating information.
Synthesis of literature findings
According to the data presented in the research works by Tolbert et al. (2019), Ayanian (2009), Garfield and Orgera (2020), and Berchick, Barnett, and Upton (2019), it is evident that the US health insurance system needs improvements to make more people have health insurance. The number of US citizens without health insurance coverage was more than 27 million people in 2018 and indicators continue on a declining slope. Over In 2018, the number of uninsured adults aged 35 to 44 and 45 to 64 increased compared to the previous year. Also, 4 million children under 19 years did not have coverage and this category of the population had one of the lowest uninsured rates in the country.
Summary of the Case
Even though there was progress due to the adoption of ACA, there is still a significant number of citizens without health coverage in the country. The state and healthcare providers must strengthen the US insurance system to enable millions of Americans to receive life-saving care. It is particularly important to provide information on various coverage providers and available options for families with low income and children. There is an information gap, and many people do not know how to get insurance and that they are even eligible for the Medicaid program. One of the ways to solve the problem is to establish a unified volunteer service. It will contribute to the dissemination of the information about how, where, and from whom to get health insurance.
Volunteer Service as an Instrument to Fill the Coverage Gap
Improving quality and value in healthcare takes collaboration among healthcare providers, the government, and citizens. It is necessary to create a service, which has local offices in each state, to deliver better value and care for the population. Through the establishment of unified volunteer service, it would be possible to solve the problem of the non-effective means of disseminating information on insurance coverage. The volunteer service aims at placing citizens at the center of care and surround them with the right insurance providers, support tools, and care management resources to get and stay healthy. It is necessary to develop a plan to establish the volunteer service, and it can be done through the application of a logic model.
Research Gap
It is important to note that even though a logic model shows a connection between what a program or service developer wants to do and the outcomes he aims for, many factors are beyond the developer’s control. The logic model is a qualitative instrument, and its development is not enough because it just illustrates what is planned to be done. The logic model can also be used as a tool to predict the outcomes but not as a source of reliable information.
Therefore, it is crucial not just to create the model but also to combine it with other research tools to be able to exercise them in practice. It is necessary to apply statistical methods and gather quantitative data to ensure that the model will work. In comparison with qualitative tools, the results obtained through the quantitative instruments are highly objective and virtually immune to the errors of human judgment.
Logic Model as a Research Tool
The logic model is a graphic or a diagram with text showing a strategy to create something new or solve existing problems. The model enables to provide information about what steps should be taken to address the problem. It can be simple or complex, consists of a few or many components. Usually, it is comprised of five categories: problem statement, resources, activities, outputs, and outcomes. Researchers note that “a logic model serves multiple purposes and can be utilized throughout the lifecycle of a program, from the planning stage to evaluation, and all steps in-between” (“Logic model”, 2016). It is a powerful way to represent what is going to be done to achieve the necessary outcomes (Casey & Sturgis, 2018). It can communicate with decision-makers and the public, and help to align activities to results. According to Humphreys et al. (2017), the logic model can be used as an evidence-based instrument to establish a strategy to plan, implement, and evaluate a health service.
Using the Logic Model for Volunteer Service Planning
Social Justice, Equity, Ethical Values, and the Volunteer Service
It should be pointed out that not all people have the same access to quality medical care. From the perspective of social justice, equity, and ethical values, every person has the right to have access to appropriate healthcare. Medical assistance should be provided for any person, regardless of his/her features, social and economic status in society. The establishment of the volunteer service does not contradict the principles of social justice, equity, and ethical values, but the turnover contributes to its promotion.
Conclusion
Although ACA has significantly decreased the number of Americans who are uninsured, the US has not achieved universal coverage. There is still a significant number of uninsured people, and the rates of low-income families and children are of particular concern. One of the ways to solve the problem is to simplify the process of providing information on health insurance. It can be accomplished through the assistance of the volunteer service established by the government in every state. It is vital to enable low-income families to become aware of all possible options and available insurance providers to reduce the national uninsured rate significantly. The support of trained volunteers can substantially improve the current situation and increase the number of insured citizens.
References
Ayanian, J. Z. (2009). America’s uninsured crisis: Consequences for health and health care. Web.
Berchick, E. R., & Mykyta L. (2019). Children’s public health insurance coverage lower than in 2017.
Berchick, E. R., Barnett, J. C., & Upton R. D. (2019). Health insurance coverage in the United States: 2018. Current population reports. Washington DC: US Government Printing Office.
Casey, K., & Sturgis, C. (2018). Levers and Logic Models: A Framework to Guide Research and Design of High-Quality Competency-Based Education Systems. CompetencyWorks Report. iNACOL.
Connolly, J., Staines, A., Connolly, R., Boilson, A., Davis, P., Weston, D., & Bloodworth, N. (2018). Evaluating impact of an emerging big health data platform: A logic model and q-methodology approach. 2018 ENTRENOVA Conference Proceedings, 6(8), pp.127-133.
Garfield, R., & Orgera K. (2020). The coverage gap: Uninsured poor adults in states that do not expand Medicaid.
Humphreys, J., Wakerman, J., Kuipers, P., Russell, D., Siegloff, S., Homer, K., & Wells, R. (2017). Improving workforce retention: Developing an integrated logic model to maximise sustainability of small rural and remote health care services. Canberra: The Australian National University.
Logic model – A planning and evaluation tool. (2016).
Status of state Medicaid expansion decisions: Interactive map. (2020).
Tolbert, J., Orgera, K., Singer, N., & Damico A. (2019). Key facts about the uninsured population.