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Problem Statement    The lack of access to healthcare services produces negative impacts to the health of an individual and the community.    Introduction    Health care plays a big role in the society especially nowadays where it has improved in a greater deal, yet still ambiguous in certain aspects. Health care has come a long way with the help of scientific research, increased economics, advanced technology and treatment. However, healthcare still needs a lot of improvement and development. Aside from the emergence of numerous clinics, hospitals and health centers, accessing healthcare services is still a challenge.Figure 1. Health Spending per Person Note. Adapted from “How Health Care Works Around the World,” by Senthilingam, 2017.    The health care industry differs in every country depending on laws, economic status and leadership. Many writings have compared the health care system in different parts of the world. Senthilingam (2017) reported about the health care system in the United Kingdom (U.K.) compared to other countries which are France, Germany, Canada and the United States (U.S.) through different aspects such as health spending per person, life expectancy, hospital services, insurance coverage and co-payment for doctor’s appointment. Through her news report, it was mentioned that the U.K. has been experiencing a few health care problems; however they were able to decrease their GDP on health care and increase life expectancy compared to other countries (Senthilingam, 2017).     The burden of lack of healthcare access causes a lot of unwanted outcomes. Many health organizations and researching bodies have presented their studies in regard to this topic addressing the importance of health care services, barriers to access, outcomes and objectives to eliminate the problem. Through the identification of these issues, interventions can be implemented. Healthy People 2020 addressed the issue of access to health services citing that good health and wellness can be achieved through all-inclusive, quality health care services.     The lack of access to health services has been a long time problem that researchers and health professionals are continuing to work on till the present. However, due to the ever changing improvement and decline in the society, every aspect of health care is constantly adjusted to cater to its purpose. The barriers to health care access also changes overtime due to many circumstances that arise from both the patient and the health industry’s side. This paper will tackle upon the issues, effects and management of the lack of access to health care services.Issues    Barriers to health care service access have a wide range of subject matter. Peters et al.(2008) developed a framework that visually explains the dimensions of barriers to health care access revolving it around the importance of the quality of health care. These dimensions are geographical accessibility, availability, acceptability and financial accessibility. Through the framework, it is explained how determinants of health and health care access contribute to the development of illness. Under the four dimensions are the different barriers itself that the patients and the providers experience.    Geographical location is a health disparity that greatly affects health care access. The location of the consumer and the supplier are both an issue when accessing health care comes in mind. Transportation issues impacts a person’s ability to get health services that are needed, and when the distance between the two locations are far apart, there is no desire for a patient to access health services. Bringing health care in rural areas is a challenge because of the distance and the travel time it takes for professionals, equipment, medicines and other services to reach the health care facility. Pines and Ernst (2017) mentioned that many rural hospitals have shut down and at the verge of closing due to low number of patients coming in, leading to financial problems. Moreover, accessing health care in rural areas becomes difficult because of the socioeconomic status of these areas. Patients reconsider the thought of getting health care due to cost and transportation issues.    The availability of health care itself is considered a barrier to accessing services. Issues with availability lean more on the health industry’s management capabilities. Providing health care services takes a long time and developing it is a long process to make sure everything runs smoothly and accordingly, so if the availability of the service becomes a problem, it is the management’s fault that situations like this are occurring. Lack of resources such as health professionals, equipment and facilities determines if health care services can function. For example, a birthing center cannot perform their services if they do not have a midwife or OB-GYN. Based on the report from the World Health Organization (WHO, 2013), due to the shortage of certified midwives, 90% of maternal death and 80% of still births happened in 58 countries worldwide. It is unfortunate how incidents like this happen when it can be prevented in many ways. If issues with the lack of health care workers continue, there will be a shortfall of 12.9 million health care workers worldwide which can bring a great disaster within the health care field in a few years (WHO, 2013). Aside from the shortage of health professionals, another problem that comes up due to availability of health care access is timeliness. Long waiting times is important to be addressed because of its effect on a person’s health. Prentice and Pizer (2007) reported through their study within a Veterans Affairs (VA) medical centers that a long waiting time for outpatient care increases the chance of unwanted death among the veterans they serve as they found a direct relationship with long waiting time and likeliness of death (p. 657). Delayed health care does not only bring negative health effects, but it also adds on to health care cost of both the patient and the health providers.    Barriers of acceptability lean toward the patient’s expectation of the service and visit. As to any other business that requires customer service, consumers expect for good service and sympathy. Once this expectation is not met, complaints arise from the consumer’s side. According to Powe and Cooper (2004), one third of their study population responded that lack of responsiveness to health concerns is the top issue in regards to the elderly’s decision in seeking for health check-ups. The elderly gets discouraged from the absence of care, especially for their age that it prevents them from seeking it. Moreover, when the service is not successful as it is supposed to be, more problems arise from the patient’s side that inhibits them from receiving health care.    Financial accessibility is one of the most influential factors of health care access. This includes the costs and prices of services and the consumer’s resource and willingness to pay for the services. Financial barrier is one of the main reasons patients decide either to postpone or not seek health check-ups at all. The cost of health care is very expensive even just for a regular physician visit. This situation can often be seen within the U.S. and other parts of Asia and Africa. This financial barrier issue can then lead to health complications. Parikh et al. (2013) reported that 13.7% of the diabetic participants in their study have mentioned about financial barriers which stopped them from obtaining important check-ups that is needed for their conditions. These financial issues limit a person’s capability of achieving good health and improving conditions. Financial accessibility is also associated with health insurance coverage whether a private and public health insurance. Insurance coverage can be considered as a barrier to health care access depending on the types of services and offers insurance companies have for their consumers. The Henry J. Kaiser Family Foundation (KFF, 2017) reported that before the enactment of the Affordable Care Act (ACA) in 2010, uninsured rate among the nonelderly peaked to 18.2%. Major changes happened in 2013 when the number of uninsured elderly went down to 16.6%, and in 2016, the numbers went down to its lowest range of 10.4% ever since health insurances started (KFF, 2017). Even though there was a decrease in the number of uninsured adults, the rate of uninsured is till high especially to the working population. KFF gathered the reasons for being uninsured among the nonelderly adults in 2016, 45% reported the cost of health insurance is too high, 22% lost their job or changed employers, 12% lost their Medicaid benefits, 10% from employer not offering health coverage, 10% is due to family status and 2% reported having no need of health coverage (2017). As mentioned earlier, the cost of a simple doctor’s appointment in the U.S. is $30 – $200 depending on health insurance, and paying for health insurance itself is also costly. This leads to the issue of health insurance coverage becoming a barrier itself to health care services. Comparing to the US, other nations such as Hong Kong, Singapore, Canada, New Zealand and many more are under the universal health coverage which provides an easier access to primary health care services without the challenges of financial incapability.    Health disparity can be associated with financial accessibility because of the resources that a person possesses. It creates an issue with accessing healthcare services because of the unwanted distance it creates between patients and providers. This problem is not something that can be solved in one sitting, but it takes time to change a person’s status. The most common health disparities that relates to lack of healthcare access are age, socioeconomic status, disability and geographical location. These health disparities can be divided into modifiable and non-modifiable ones, meaning that the others can be changed such as socioeconomic status, geographical location and disability. However, age is not changeable. Different health organizations and studies have presented their very own set of health disparities that affects healthcare access. It is a problem because of the unequal experiences and treatment in the health care field. Other studies have pointed out disparities in more detailed versions. Dr. Ananya Mandal (2014) listed some health disparities in access to health care which are lack of health insurance, lack of financial resources, irregular source of care, legal obstacles, structural barriers, lack of healthcare providers, language barriers and age. These disparities create a gap between healthcare providers and the patients.    Basing on age groups, majority of the elderly is usually the most vulnerable population especially within health. Older individuals suffer to more health conditions due to deterioration of body functions. In addition, the issue about income takes place. Since most adults are retired and have no steady source of income, it is difficult for them to receive health care services because they have no means to do so, especially with developing disabilities and health deterioration. Even though there are health insurance and benefits provided from their previous employment, some personal instances hinders them from accessing health care such as transportations issues, medical bills, street safety, fear of discovering a serious illness and fear of unneeded tests (Powe & Cooper, 2004, p. 1790).    Another health disparity that becomes an issue when lack of health care access is in talks is disability. The World Health Organization (WHO, 2016) reported that more than one billion (15%) individuals around the world are suffering from some sort of disability, with the numbers keep rising due to health conditions and the ageing population. Disability limits a person’s capability of performing normal daily activities. Disabled individuals are in need of more strenuous medical attention. Furthermore, they may require special health attention, but they are also in need of the general health assessment that people with no disability receives. Prohibitive costs, limited availability of services, physical barriers, and inadequate skills and knowledge of health workers are identified as barriers to health care services (WHO, 2016). These barriers make it more difficult for disabled individuals to access health care which leads to unmet health needs and hardship.Effects    With no access to health services, it is not a surprise that there are health consequences that can occur which can range from small injuries to deteriorating health problem and also death. Healthy People 2020 identified a few of the impacts of lack of health care access to the patients which are unmet health needs, delays in receiving appropriate care, inability to get preventive services, financial burdens, and preventable hospitalization. These burdens are more likely due to the patient’s health insurance coverage. Less coverage delays a person’s ability to access health care, and it leaves a harmful impact to their health. The Institute of Medicine (2009) released a report where they have mentioned a few of the harmful effects of lack of health insurance among the adult population which are acute ischemic stroke, cancer, congestive heart failure, diabetes, heart attack, hospitals in patients with serious acute conditions, hypertension, and serious injury or trauma. Many of these burdens are preventable; however the health care system in a country can greatly affect the community’s health status. Management:    Solving the problem with health care access can be addressed in multiple ways and in different aspects. The WHO suggested some intervention that can be used to address the problems of lack of health care access which are policy development, increased insurance coverage, financing, service delivery, human resources and data and research. Aside from the suggestions of the WHO, education and sustainability should also be considered.Policy Development    The Government is partly responsible for the health status of the people. It is also its responsibility to assure that health services that are offered would target the health needs by the entire population. The government has the authority to change laws and legislations that will greatly affect the health care system which is why approaching the government will help better the heath system. It is important to identify which existing laws are in need to be revised or replaced. Jacobs et al. (2011), proposed of having the government and non-government sectors work together to address the issue by reviewing the regulation, and ensuring it serves as it supposed to before doing other interventions. As time goes by, many of the legislations may not be applicable in the modern society. An administrator should be able to identify these laws, and reach out to the law makers to change the policies. Administrators should review the legislation and determine which ones still works, and update the ones that needs to be changed. Aside from initiating an update with the health laws, it is also an administrator’s responsibility to reach out to the law makers and convince them on creating new laws that will help with health care access such as insurance coverage laws. An administrator can receive support from its staff through rigorous research that will be used as evidences that can be presented to law makers for the credibility of the subject.Increased Insurance Coverage    Insurance should be available to everybody most especially the vulnerable population: elderly, children and disabled. One of the main reasons for lack of health care access is the absence of health insurance. The elderly, children and disabled individuals are the ones that are in need of medical attention, however due to having no capabilities of acquiring health insurance coverage their access to health services are less likely. As mentioned earlier, many factors play into account that hinders the vulnerable populations from acquiring health insurance. Private and public insurance have their downfall depending on the services that needs to be availed. Public health insurance should widen the range of the population that they can serve. The universal health coverage is a great option for primary health care service access because fees for these services are not necessary. Health administrators are responsible of developing plans on how the uninsured population can access health care. This can be done through the help of federal grants. Applying for federal money that focuses on providing quality care to the uninsured population is a way for them to receive health services. Financing    Cost of health care is an on-going issue even with the decrease of the number of uninsured individuals. An administrator should be able to plan services that are available to everybody regardless of health care coverage. Most of these services should address the primary health care for the community. Places with universal health care have easy access to primary care services without the burden of having to think of the cost of care; however in countries such as the U.S. and parts of Asia and Africa, it is not easily accessible due to cost. Financing health services can be very critical because every expense that is made should be justified. It is important that a health administrator knows how to use money wisely, and instead of spending first, administrators should find ways to use available resources. A health care administrator should be able to come up with a plan on how to minimize the cost of accessing services. One way to do this is through collaboration with other health organizations that provides the same services. Through collaboration, costs of service operation can be divided between the organizations, and resources that one organization have can compensate for the other. Another way to lessen cost in providing health services is through an incentive system that will encourage the patients to receive health care. An example for this is free gas cards whenever patients use their personal transportation for health purposes.Service Delivery    The way services are delivered to the patients is a strategy that will let health providers bring in more people that will need the care. If the community is having difficulties with going to health check-ups, then try to bring the services to the people. A good example of this is the Directly Observed Treatment that Tuberculosis (TB) programs provide. The TB staff goes out to the field to deliver medicines and observes patients when they take the medicines because of the harmful effects and consequences that the medicine creates when not taken in a regular manner. The medications are not given to the clients for them to take by themselves because it can cause drug abuse, and the side effects of the drugs can cause health deterioration that needs to be addressed immediately. Since the medications are supposed to be taken every day, clients do not have the fortune to go to clinics just to take medications. Going out to the client’s themselves is a more effective strategy.Human Resources    One of the reasons for the lack of availability of health services is the shortage of health professionals that can serve the population. A health service cannot function without the specialized professionals that have the knowledge and skills to provide certain services. When this issue comes in, health administrators should be able to manage providing services with the limited human resources she currently have. This is where training and education opportunities should be implemented. An administrator should plan workshops for their staff that will certify and train people to hone their skills that will be helpful in the health care field, and that will stop them from relying to the same personnel. In addition, some reasons for shortage of staff are due to management itself. A good administrator should have leadership skills that will increase staff retention rate. The administrator should provide a working environment that will not harm the staff. Recognition of the work done by the staff is important, instead of bringing down the staff; the administrator should be able to support them in aiming for higher goals.Data and Research    Data and research is the best way to assess the community needs and health trends. Through research, administrators would be able to gain information of plans, actions, theories and systemic models that will help them to address situations in certain ways. Through needs assessment, health providers would be able to identify the reasons as to why some people do not seek for health services. After identifying the problem, researchers can conduct investigations that will be able to lead them to the root cause of the patient’s lack of enthusiasm of consuming services, and then planning for intervention can take place. Research can also be used to gather information that will help administrators plan actions that will cater towards the root cause of the problem.Education    As a part of the outreach services of some programs, educating the people about health and health programs would help bring in more patients to access health care. Healthy People 2020 has a goal of increasing the quality, availability and effectiveness of education and community-based programs designed to prevent disease and injury, improve health and enhance quality of life. When people are aware of the consequences of their health complications, they will take the initiative to access health care regardless of the unfortunate circumstances that might have happened before. Through education, the community will also be aware of the free services that are provided for them. Instead of waiting for patient’s to come in when their conditions are at its worst, encourage them and let them know about services that will help prevent health complications.Sustainability    Having services maintain the quality and safety is very important not only to the outcomes that it produces, but also to the patient’s decisions of consuming them. To maintain sustainability with health services that are offered, the administrator should have a regular evaluation procedure that will assess if the services are doing progress and heading to achieve the goal. If an administrator sees a decrease or error with performance, action can be provided. It is important the maintaining the quality of services is strictly observed and evaluated  because it can affect not only the business, but also the patient’s decision of seeking for health care.Conclusion    The lack of health care access is an event that can be prevented when addressed properly. It requires effort from both the individual and the health providers’ side to make health services accessible. The health care system for every country might be different due to the economy, leadership and other factors, but knowing and learning from the more developed health systems will help the less developed ones. After identifying the barriers and interventions that can take place, the structure of the health system itself would need adjustments and modifications that will be able to cater to everyone. Many of the barriers to health services access are financial, but it can be resolved with good strategic planning on the health provider’s side on reaching out to the population who has issues with cost. Other factors that affect a person’s ability to access health services can be addressed when identified. The lack of health service access creates the unwanted gap between patients and providers. Addressing the issues with lack of health care access is a difficult task that will require a lot of effort not from one individual or organization only, but from a collaboration and support by everyone who are accounted to provide the best quality care to the community. Health care administrators are responsible of assuring that services will be available to everybody regardless of their status in the community, prioritizing the most vulnerable population, and evaluating the quality of services that are provided.

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