FACTORS INFLUENCING ACCESSIBILITY AND AFFORDABILITY OF HEALTHCARE IN THE USA.

Introduction

With the United Nations listing health care as natural born right, the escalating cost of health

care in America has reached a debatable crisis. Many people in the USA could not access

required health care in a timely manner because of the lack of affordability. Even if you do have

insurance it's a financial strain on most families. In many other countries the health care is

government controlled and all citizens are provided government assisted health care. Most

systems over in Europe are indeed government controlled and are taxed by wages. The United

States government does not pay for most of its citizen’s healthcare in contrast. If you are

fortunate enough to afford insurance it's usually through your employer. In comparison almost

all government operated insurances provide better care for babies and pregnant mothers than the

United States system of health care. The United States system are more flexible than government

aided systems though. Most of their healthcare facilities are largely owned and operated by

private sector businesses. The US does not have a universal health care program unlike most

other developed countries, instead healthcare coverage is provided through a combination of

private health insurance and public health coverage, i.e Medicare. The Patient Protection and

Affordable Care Act (PPACA) aka Obamacare, was implemented to increase access to medical

care by improving affordability. However, not only are some people losing their insurance

coverage, but the size of vulnerable populations is growing. Progress against several health

problems is blocked because of poor access to health care. The news media frequently depicts

the plight of poor unwed pregnant adolescents, children in low-income families, the homeless,

minority groups, residents of rural areas, and refugees. When the focus shifts to whether we are

making headway against specific diseases, the disparity in health status between vulnerable

groups and the general populace becomes apparent. With respect to HIV/AIDS, drug abuse,
cancer, and infant mortality, less favorable outcomes are often attributed to the inability of some

segments of society to gain timely access to essential health services.

Many besides the poor may have difficulty getting access to health care. Those with pre-existing

disease conditions fear that they will lose insurance coverage if they change jobs. Middle-income

people fear that shrinking insurance benefits will force them to pay more and more of the costs

of health care, increasing their reluctance to seek care when they need it. The US is a clear

example of what happens when medical care becomes a commodity in trade rather than a social

service. US, alone among all advanced Western countries, has allowed its healthcare system to

become a market and its physicians to behave as if they were in business. In the US medical care

has become a huge, competitive industry with many private investors, but with relatively little

government regulation. Involving more than $2.7 trillion (£1.7 trillion; €2 trillion), the US

healthcare industry now constitutes nearly 18% of the entire economy and it continues to expand.

The essay below will discuss the causes and effects that influence affordability and accessibility

of healthcare in the US.

AFFORDABILITY

USA pays almost four times as much for pharmaceutical drugs as citizens of other developed

countries. In other countries, Prices for drugs and healthcare are at least partially controlled by

the government. However, in the US medical market, those who largely control the supply of

services (physicians) also largely determine the demand. Of course, the patients’ complaints,

illnesses, and injuries also play an important role, but it is the physician who interprets them and

knows what services are needed for diagnosis, treatment, and prevention. It is also the physician

on whom the consumer (that is, the patient) relies for advice. The fee for service payment system
through which most physicians are paid gives them a strong economic incentive to be overly

generous in their recommendations and provision of services, especially since they are well

aware of their reimbursement for the services they provide, but are usually unfamiliar with the

charges made to insurers by laboratories, hospitals, and other facilities for the services they

recommend.

These facilities, whether paid for each individual item of service or for an episode of care (for

example, a day in the hospital or a visit to a clinic), also have strong economic incentives to

maximise the volume of their profitable services and increase the referral of paying patients. So,

in addition to direct marketing to consumers, they encourage doctors to use their facilities and to

refer patients by offering many kinds of favours and financial arrangements. Medical products

(prescription drugs, devices, and equipment), which account for more than 15% of costs, are also

promoted by manufacturers like commodities in trade rather than being used only according to

medical need. Marcia Angell’s much discussed 2011 article documents this behaviour by

manufacturers of psychoactive drugs. To increase their sales, manufacturers depend on direct

marketing to patients, and give financial and other inducements to the physicians who prescribe

them. While not unique to the US, these practices are more pervasive in the US than elsewhere.

The conflicts of interest that stem from attempts by manufacturers to influence the behaviour of

physicians add to the unnecessary costs of the system hampering access to healthcare services by

low income and vulnerable families.

Hospitals, doctors, nurses all charge more in the US than in other countries. New technologies have

seemed to be the driving force of high healthcare cost in America. The technology accounts for 38 to 65

percent of healthcare spending in America (Johnson, 2011). The annual spending of health care increased

from 75 billion in 1970 to 2.0 trillion in 2005 and is estimated to reach 4.0 trillion in 2015 (Kaiser
Foundation, 2013). U.S. citizens spent 5,267 per capital for health care in 2002- 53 percent more than any

other country” (2005). “America spent 5267 per capital and in Switzerland they spent 3074 per capita”

about 1821 cheaper than ours (Starfield, B 2010). Controlling the technology isn’t easy thing to do

because of technology prices are set by manufacturing and the installer of the new medical equipment’s.

These high prices in turn leads to unmet health needs and can also lead to preventable hospitalizations as

with these high prices, it hinders the access of healthcare services due to the high costs hence preferring to

stay home.

Covid-19 has however increased pressure on the highly complex and expensive healthcare system,

making it more urgent to lower costs in order to improve access to healthcare services among all

American citizens.

ACCESSIBILITY

Access to health services means the timely use of personal health services to achieve the best health

outcomes. In the US, this means gaining entry into the healthcare system, usually through insurance

coverage, accessing a location where needed healthcare services are provided depending on the

geographical location and finding a health-care provider whom the patient trusts and can communicate

with on a personal level. Access to care often varies based on race, ethnicity, social-economic status,

disability status, age, sex, residential location.

Patient related factors that contribute to the ailing accessibility of services in USA include: social-

demographic variable depending on where the patient is from if there is a hospital nearby. The patient co-

operation is also key to access to quality medical services as this gives the medical practitioners a basis

for a right prescription. The type of patient illness can also affect their access to healthcare providers,

especially In the Covid-19 era. The stigma around the corona virus has restricted people with underlying

medical conditions to seek access to these healthcare providers with fear of contracting the virus.
Lack of affordability in the US healthcare system has also adversely impacted accessibility of

medical care even after implementation of PPACA. Increase in affordability through various

policy measures is required to improve accessibility to medical care among vulnerable groups. A

large percentage of Americans have inadequate or no insurance coverage.

This leads to Financial burdens among these vulnerable Americans and also causes delays in

receiving appropriate care for patients who need emergency attention. The inability to get

preventive services due to the complex and expensive insurance based system that extorts its

patients just so they can access a basic human right. What do you do when sickness occurs, if

you aren’t rich? Suffer the illness for sure, and then suffer the out of pocket costs after wards.

Tens of millions of Americans under age 65 don’t have any health insurance at all.

BOTTOMLINE

For low paid Wage workers, the unemployed and undocumented migrants living in the US ,

getting sick or having any kind of medical mishap is a disaster. For them, paying out of pocket

costs of any sort may simply be impossible. To put this into perspective, 40% of Americans can’t

afford an extra 400$ even in a medical emergency. Imagine what 5,000$ or 10,000$ in expenses

mean!

Though Barack Obama’s Affordable Care Act aka Obamacare helped significantly, there are still

far too many people who will have to agonize over how to manage both an illness and the co-

pays that go with it. All the talk about making insurance affordable, under present medical

circumstances in USA adds up to just so many wasted words. Unless something changes big

time, Insurance companies will continue to sell their services at even higher prices because we

cannot do without them.

Health is not a negotiable factor. It should be as much of a right as public education. Good

healthcare must not only be affordable but also provide easy access to medical services,

nutrition, a healthier environment and greater longetivity.

REFERENCES

National Healthcare Quality Report, 2013 [Internet]. Chapter 10: Access to Healthcare.
Rockville (MD): Agency for Healthcare Research and Quality; May 2014. Available
from: http://www.ahrq.gov/research/findings/nhqrdr/nhqdr15/access.html

Access and Disparities in Access to Health Care [Internet]. Rockville (MD): Agency for
Healthcare Research and Quality; May 2016. Available
from: http://www.ahrq.gov/research/findings/nhqrdr/nhqdr15/access.html

Squires DA. The U.S. health system in perspective: A comparison of twelve industrialized
nations. The Commonwealth Fund, July 2011.

National Healthcare Quality and DIsparities Report 2014 [Internet]. Key Findings. Rockville (MD):

Agency for Healthcare Research and Quality; April 2015. Available

from: http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/key1.html#Access