The primary purpose of this study was to determine the disparities in access to health care and analyse the rationale of the types of policy intervention solutions globally to address the contemporary health issue in education and training, tax benefits and payments to caregivers, respite care, business regulations combining work and care giving, and financial support and provision of pension credits for care giving. The study was descriptive in nature. The data were analysed and interpreted.
Having a broad variety factors that plays a role in health disparities, it is very demanding and challenging to clarify the determinants of health disparities. For individuals who are challenged with sociodemographic status, physical disabilities and affected by inevitable circumstances such as calamities or disasters are crucially to escalate likelihood of health disparities that may lead their later life to health-related problems.
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Given the fact that people under these situations are most unfavourable groups in society with regards to income, education, employment, living condition or occupation, health disparities is more anticipated to exist. In this instance, it is essential to obtain which factors bring about to the health disparities.
This study is looking forward to initiate further interest in health disparities among policy makers. Particularly, this may help health care professionals better understand the present picture of health disparities and its causes. Correspondingly, the prevention and elimination of health disparities of the population and their outcome improved quality of life will be regarded.
The purpose of this study was to identify the determinants of health disparities in health care access and to produce policy intervention solutions based on education and training, tax benefits and payments to caregivers, respite care, business regulations combining work and care giving and financial support and provision of credits for care giving. To achieve these purposes, the occurrence and determinants of the health disparities were investigated in these scopes: lack of insurance coverage, lack of financial resources, structural barriers, shortage of health care providers, linguistic barriers, health literacy, discrimination and age.
This study is anchored to the assumption that disparities in care can greatly affect the access of health care. This is explained in the diagram below:
Figure 1. Theoretical Framework for Disparities in Access to Health Care
According to Anderson (1995) in the behavioural model of health services operation, population characteristics feature three main components: (1) predisposing characteristics, (2) enabling resources, and (3) need. The predisposing characteristics embody the following elements: (a) demographic aspects, such as gender, age, or marital status, (b) social structure, such as race/ethnicity, education, religion, or occupation and (c) health benefits, such as knowledge about disease, values about health and illness, and attitude toward health services. The predisposing characteristics affect enabling resources in family, person and community. Personal or family enabling resources involved knowledge regarding access to and utilisation of health care and manner to access health care, while community enabling resources integrate available health facilities and personnel. The above-mentioned enabling resources have an effect on one’s perceived and evaluated health need. How people belief or think of their health status is referred to as perceived health need, while indication of professional judgment relevant to people’s health illnesses or conditions and their stand in need for medical treatment is referred as evaluated health need.
The foregoing population characteristics – predisposing characteristics enabling resources, and health need will exert influence on one’s personal health practices; use of health services; and health behaviour. Lastly, one’s health behaviour impacts health outcomes: (perceived) health status and (evaluated) consumer satisfaction. In Andersen’s (1995) phase 4 of the behavioural model environmental factors –external environment and healthcare system – having been lately included, and these factors affect the population characteristics as well as health outcomes.
- The impact the disparities of access to health care would have on national and international healthcare policy.
In the study, health disparities throughout different nations including New Zealand were analysed in access to health care. On top of that, the determinants and existence of such disparities have been focused on. It ought to indicate that access to health care itself affects one’s health needs, enabling resources and predisposing characteristics. Nevertheless, further attention is here centered on the direct impacts of the determinants on health care access. Considering the dynamic and intricate structure of health care access, social demographic characteristics are broadly addressed to determinants of access to health care. The association between access to health care and health status is examined in detailing the determinants.
Based on Healthy People 2020 definition of health disparity is “a precise type of health difference that is intently associated with economic, social and/or environmental unfavourable circumstance. Health disparities unfavourable influence groups of people who have consistently undergo considerable obstacles to health stands on their ethnic or racial group; socioeconomic status; religion; age; gender; sensory, cognitive, physical disability; mental health; gender identity or sexual orientation; geographic location; or other characteristics typically connected to exclusion or discrimination.
A range of sociodemographic characteristics, such as lack of insurance coverage, lack of financial resources, structural barriers, scarcity of providers, linguistic barriers, health literacy and age are involved in access to health care. These sociodemographic characteristics are correlated with not only one another notwithstanding further determinants in different area.
Considering health insurance coverage and status issues play an important part in access to health care and these matters are similarly concomitant to other sociodemographic components, analysis on sociodemographic characteristics is frequently focus on health insurance issues. In the absence of health insurance, patients are most apparently to delay medical care; it appears to go without needed medical care, and probably to go in the absence of prescription medications.
Despite the fact that the insufficiency of financial funds is a barricade to health care access for many nations, the influence on access become evident to be pronounced for minority populations. Structural barriers include excessive time spent in the waiting room, an inability to schedule appointments quickly or during convenient hours and poor transportation, each of which influence person’s willingness and to acquire needed care.
In rural areas, high cities and communities with great congregation of minority populations, access to medical care may be restricted because of the shortage of, specialists, primary care practitioners and diagnostic facilities. Furthermore, language differences (most especially those non-English proficient minorities) impede access to medical care.
Health literacy is about patients having problems understanding, obtaining and processing basic health information. To give an instance, patients with a deficient comprehension of good health may not knowledgeable when it is needed to attempt to find care for definite symptoms. Although issues with health literacy are not confined to minority groups, the situation may further utter in these groups due to educational and socioeconomic factors.
Age may as well be a determinant in health disparities for particular reasons. As numerous older individual draw breath on fixed incomes this can create paying for health care expenses burdensome. Besides, they unlikely encounter other hurdle such as lack of transportation or weaken mobility that makes accessing health care services difficult for them physically. Moreover, they cannot have the possibility to access health information through the internet over their age. This may place older individuals at an unfavourable position in terms of retrieving important information regarding their health and by means to protect it.
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Communication is vital for the delivery of effective and appropriate care and treatment, despite of a patient’s culture, and miscommunication may result to improper use of medications, incorrect diagnosis and failure to undergo follow-up medical care. The relationship of patient’s provider is reliant on the capacity of both individuals to efficiently communicate. Culture and language both involved in significant task in communication in the course of a medical consultation. Among the patient populace, minorities appears considerable amount of difficulty in conveying concerns and understanding with their physicians.
In stand of the Health Care Quality Survey conducted by the Commonwealth Fund (2001), American patients during interview responded that nineteen percent (19%) of the time they experience difficulty communicating with their health providers which included feeling doctor listened, understanding doctor, and had questions yet did not enquire. As oppose to the Hispanic population comprise the relatively large problem communicating with their health provider, thirty-three percent (33%) of the time. It is fact that communication is associated to health outcomes, as communication enhanced so certainly patient satisfaction which result to enhanced compliance and will progress health outcomes. The result of incapacity to communicate with care providers has influence the quality of care.
Language takes significant role in communication and determined attempt need to take hold to make sure perfect communication involving patient and provider. Those non-English speakers that utter the need of an interpreter in the time of clinical visits proclaim having one. In the absence of interpreters in the course of clinical visit add up to the communication barrier. Moreover, incapacity of providers to convey information with deficient English proficient patients results to, more invasive procedures, over prescribing of medications and more diagnostic procedures.
Poor communication is a factor to compliance of medical services and health outcomes. Heaps of health-related environments make available interpreter services for their deficient English proficient patients. It is indeed been helpful when health providers do not communicate the similar language as the patient. But, there is ascending affirmation that patients require communicating with a language concomitant physician to sustain the desirable medical care, be satisfied with the care experience and bond with the physician.
Further communication difficulty upshot from a decrease or reduce of cultural proficiency by health providers. It is also a great value for health providers to be aware of patients’ health practices and beliefs unescorted judgments or reactions. Comprehending a patients’ perspective of health and disease is essential for treatment and diagnosis. So health providers required to assess patients’ health practices and beliefs to refine quality of care. The health decisions made by the patients can be influenced by cultural beliefs, sceptical Western medicine, and hierarchical and familial roles, every single one of these a white health provider may not be familiar with.
Another disparity could be discrimination. This is where health care providers likewise consciously or unconsciously handle certain ethnic and racial patients distinctively from other patients. It may be because of stereotypes that health providers may have concerning racial/ethical groups. Physicians are more possibly to set down negative cultural stereotypes among their minority patients. It may happen despite of high regard for personality characteristics, income and education.
Meanwhile the United States of America favour the term health disparity, some other countries more usually utilise such terms as health inequity or health inequality (Carter – Pokras & Baquet, 2002). Specifically, the word health inequalities are more commonly used in New Zealand, Europe and Great Britain. According to Harper & Lynch (2005) health disparity includes elements of both health inequality and health inequity. Moreover, inequality is a difference that can be observable and measurable; on the other hand inequity encompasses an ethical judgment participate in resolution of the difference.
Moreover, in relation to global health disparities discussed, three of the ten (10) facts about health inequalities in Aotearoa New Zealand based on New Zealand Medical Association and University of Otago prepared by Tony Blakely and Don Simmers (June, 2011) has similarly contribute to the access of health care. These include:
(1) Almost all other countries, there is inclination of increasing mortality or exacerbating health right from one side of the affluent to deprived, socio-economic hierarchy, or from rich to poor and most educated to least educated. The socioeconomic differences have made mortality rates broadened in corresponding terms until year 2000, yet have inclined to be stable after all. A close basis of expanding disparity in life expectancy via income about 2000 is indeed apparent. Those people in the top-level of incomes have a 5-6 year satisfaction in life expectancy in contrast to the lowest. New Zealand is level at about average for rich countries in the realistic magnitude of socioeconomic inequalities in mortality.
(2) An unequal division of social determinants such as housing conditions, employment, and income conditions is crucial to driving health inequalities. Unemployment and economic conditions ameliorate between 1994 and 1998, and there is a fall of child poverty. In distinction to, 1998-2004 rates diversified be conditional on the measure, afterwards with Working for Families child poverty momentum cut down from 2004-2007.
(3) Behavioural predisposing factors and health services as well come up with inequalities of health. Tobacco is exceptionally significant, as to healthy eating. Health services is further substantial, primarily as the efficacy of supportive care and treatments to both decrease morbidity and mortality happen to be more effective and more great in number.
- Discuss and critically analyse the rationale or justifications for putting into place each of the below listed types of policy intervention solutions globally to address the contemporary health issue highlighted in disparities of access to health care
Education and Training
Institutions should consider conducting research to determine up-to-date and effective policy and program solutions to lessen or diminish health disparities. It is essential to conduct outreach to expand the diversity such as racial/ethnic, disability, income in health care and public-related health careers. They should put forward preventive services (such as vision, oral care, hearing screenings and mental health services) for all children and elderly, particularly those at risk. Lastly, they have to develop and carry out local plan of action to reduce psychosocial, environmental conditions and health that take hold of access to health care.
Tax Benefits and Payments to Caregiver
Increase tax benefits and refunds for those who have below minimum wage workers and use data to spot populations at greatest risk and partner with communities to implement government programs and policies on mitigations that addresses highest priority health needs. Government should allocate good payment, health benefits and remuneration to caregivers because they are the first line of health providers in terms of access to health services needed by the people.
This type of care should be available and accessible every time the concerned individual needed it such as caring for disabled individual and older clients. Expand the communication and cultural competence of health care providers in the respite care service. Train and hire further qualifies staff from marginalised ethnic and racial minorities and people with disabilities. Intensify care systematisation and quality of care like integrated care teams.
Business Regulation combining Work and Care giving
Health markets should comply with statutory policies and regulations concerning medical costs, availability of health services and health care professionals, equal treatment of patients especially those who belong to minority group and children, pregnant woman, chronic conditions or disabilities and elderly, and lastly, consider the community’s needs and demands of health care.
Financial Support and Provision of Pension Credits for Care giving.
Involved all professionals from a variety of sectors (such as labor, health, education, environment and transportation) with community representatives to make sure that community health needs are recognised and that needs and barriers are attended. Expand cheaper or affordable health services that will ameliorate favourable chances for health care coverage and access as component of efforts to lessen disparities among individuals who are deprived of health.
It is a fact that health is vital to human existence. A person cannot perform his activities of daily living without being on a state of wellness. In this study, there are numerous factors that brought about disparities of access to health care. The essential qualities of health disparities evaluated were lack of insurance coverage, lack of financial resources, structural barriers, shortage of health care providers, linguistic barriers, health literacy, discrimination and age. Most of the population affected by these circumstances are minority groups, children, pregnant woman, chronic conditions or disabilities and elderly.
To deliver policies further productive and effective to eliminate and prevent health disparities, understanding of scientific facts in determinants of health disparities is vital. In addition, it highlights the prominence of factors outside the immediate authority of the health sectors particularly the social welfare, labour, housing, market sectors, local government and education, in shaping the health of the population. On the other note, accomplishment in alleviating disparities in health leads to positive results for the individual, society and economy.
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