Health Care Access and Disparities essay

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Choose and identify a population to study.

The chosen population to study is the Filipinos. Statistics indicate that Filipino Americans are the second fastest growing Asian immigrant group in the United States of America (Sanchez & Gaw, 2007). There is yet health care concerns of Filipino's who represent a diverse mixture of culture, beliefs and practices and vary widely from other minorities as well as from the larger population. Sanchez & Gaw (2007) noted that close to 2.9 million Filipinos reside in the United States in which the highest populations are found in California, Hawaii, and the East Coast.

According to Sanchez & Gaw (2007) Filipinos are known for their industriousness and upward mobility, and they have the highest rate of labor participation among all Asian groups at 75.4%. In addition the majority of Filipino Americans live with family members and a third of families have more than five members and therefore they face barriers of health care access. They have also the highest rate of interracial marriages among Asian minorities which influences acculturation, ethnic identification, and self-perception.

Analyze the aggregated data that identifies the barriers and health care disparities.

Data analyzed from 292 Filipinos indicates that this community in USA has a varied access to health care services and utilization (Yu, Huang & Singh, 2004). Yu, Huang & Singh (2004) noted that Filipino children are likely to miss school because of illness. They further said that Filipino children are more likely to be without contact with a health professional within the past 12 months. Yu, Huang & Singh (2004) established that "citizenship/nativity status, maternal education attainment, and poverty status were all significant independent risk factors for health care access and utilization."  

There is a variation of health access for the Filipino Americans. Data analyzed by McBride (2007) indicated that 89% spoke a language other than English, 56% did not speak English well. It was also noted 43% of the Filipinos in the data had less than 9th grade education. 18% were unemployed and 8% lived in poverty. In addition 14% were related to cultural beliefs of the Filipinos. These were regarded as some of the disparities that caused barriers to health care access among the Filipinos. McBride (2007) says that English proficiency was a cause for disparity especially for the immigrants because many feel insulted when asked if they need an interpreter.

Cause of Health care disparity

Percentage population (% of 292)

Language barrier (immigrants)

89

Education

43

Poverty

8

Unemployment/ Lack of health insurance

18

Culture related issues

14

In order to properly to come up with correct data about Filipino health care surveys with Filipino American was gathered of 292 individuals to assess health priorities and barriers. Open ended interviews were prepared that were given to 5 community leaders. This data was critical to evaluate health care barriers that results to disparities among the Filipinos. Through this data the team was capable of creating appropriate outreach strategies to reach a sample that was a representative of the general Filipino population access to healthcare services.

Identify how regulations, legislation, and policy in private and public areas may influence the health of individuals in the chosen population.

Research indicates that one out of six Filipinos is uninsured in the United States. Chen (2008) established that Filipinos are more likely to not have a usual source of care hence the barriers to accessing healthcare not only include being uninsured or underinsured. Another cause is changing federal and state policies, language barriers, and racial bias in the delivery of health care services. It is important to note that access to healthcare and health for Filipinos are interconnected, this has consequential health outcomes for this community.

Consequently, health insurance provides access to primary care. As a result Chen (2008) says that "lack of health insurance, along with low socioeconomic status and adverse health behaviors among the Filipinos has affected health care seeking and health outcomes" (p. 329). Chen (2008) also indicated that Filipinos who lack health insurance coverage also experience more a decline in their health and have an increased chance of premature death. Lack of health care among this population decreases the use of preventive services, delays disease diagnosis and leads to poor monitoring and control of chronic diseases.

Filipinos in particular immigrants continue to have less access to basic primary and preventive health services than does the general US population because they are likely have low incomes and disproportionately comprise America's uninsured (p. 329). Chen (2008) further noted that health insurance is often unaffordable for low income people and for those who are self-employed because of high health premiums (p. 331). It was therefore found out that lack of health insurance provides a major deterrent to receiving timely and appropriate health care.

Changing federal and state Medicaid policies for immigrants have also put public insurance out of reach for many low income Filipinos. Chen (2008) says that "both documented and undocumented may not use publicly funded health services because they fear deportation and worry about jeopardizing their immigration status. Chen (2008) indicated that "based on policy changes they may not know whether they qualify" (p. 331).

Changes to Medicaid, anxiety over jeopardizing immigration status or hopes for citizenship has led to decreased Medicaid participation rates for low income Filipinos. Chen (2008) mentioned that policies to restrict eligibility or increase the complexity of enrollment significantly affect low income and working class Filipinos families. In case of Medicaid, restrictive and cumbersome federal eligibility and enrollment requirements have prevented many Filipinos from accessing state insurance programs.

Identify the impact of health care disparities on the chosen population.

Access to health care for Filipinos is affected by disparities in health care interactions between providers and patients but also in coordination of care. Chen (2008) says that differences in education, English language ability and health care insurance are accounted for Filipinos who are able to access health care still face substandard health care in that many are often referred to preventive screenings or counseling with less frequency and often a lower quality of care than whites.  

Health care disparities cause counselors and clinicians to lack the awareness of the influences of racial/ethnic identity development and their relationships with doctors (Nadal, 2010). These disparities cause Filipinos who are generally classified as ethnocentric to have difficulty in trusting clinicians who are white. This again widens their therapeutic relationships as well and discusses racial dynamics (Nadal, 2010).

Explain how disparities impede health care service delivery for the chosen population.

Filipinos patients are less likely to report that they were very satisfied with their care overall and therefore they were less likely to have a great deal of trust in their doctor (Chen, 2008). Also Chen (2008) says that Filipinos are less likely to have doctors who adequately understand their background and they were less likely to have a doctor who knows their medical backgrounds. They also felt not listened to by their doctors. As a result these poor doctor patient interactions often translates into less doctor patient communication about nutrition and physical activity and less follow-up care for crucial health issues such as mental health.  

According to McBride (2007) it is considered disrespectful to challenge, question, or express disagreement with an authority figure such as a health care provider. He further says that that to encourage open communication, providers need to reassure a reticent or passive elder that asking questions or expressing opinions would not offend them (McBride, 2007).

Identify barriers to health care access for the chosen population that may impact health care disparities.

Many Filipinos attribute the barriers to their race and their limited English ability. Chen (2008) says that elderly Filipinos have said they received poorer care and were less likely to be offered important cancer screenings and diabetic services. He further says that lack of access to these important screenings has an impact on the continued disparity not only in access but also in quality of care. We can therefore conclude that these disparities affect morbidity and mortality. Research shows that language and cultural barriers can pose a major disparity among the Filipinos. Filipinos by the fact of not knowing English well has an impact on health care access.

Cultural values act one of the major barriers for the Filipinos especially the elderly. McBride (2007) established that "many contemporary Filipino American families continue to function in a complex process of a natural support system of reciprocity within interdependent/dependent relationships based on extended family membership, group harmony and loyalty, respect for elders and authority, and kinship that goes beyond strong biological connections." This therefore has for long acted as a barrier to health access for the Filipinos.

Poverty is another barrier that has caused disparity in health care access for the Filipinos. Having a population of 8% Filipinos living in poverty implies that they cannot access health insurance and therefore they cannot receive health care services provided by the government. On the other hand education is also a barrier because lack of its basics means that the Filipino population normally has issues in interpersonal communication especially in expressing themselves.

Identify positive and negative impacts of health care disparities on past, present, and future health care delivery for the chosen population.

It has been noted that some states have opted to use state-only funds to extend benefits to some low income immigrants exclude from Medicaid and SCHIP under federal policy, but as the recent economic downturn affects state budgets. According to Chen (2008) the recent changes to Medicaid enrollment procedures have posed significant barriers even to U.S citizens who must now comply with new citizenship documentation requirements passed.

Federal restrictions to the State Children's Health Insurance Program eligibility preventing states from covering children in Filipino families with incomes that is above the poverty level (Chen, 2008). For the working class Filipinos particularly the self employed or others without employer-based insurance, the new restrictions on states regarding State Children Health Insurance Program eligibility and the inability of Congress to provide strengthened federal funding, curtail their ability to obtain affordable insurance for their health care services (Chen, 2008).

Suggest the evolution of programs that may be supportive in the efforts to improve health care access for the chosen population.

Chen (2008) says that better data is needed to fully understand the needs of these populations in order to develop culturally and linguistically appropriate solutions for improved access to quality health care. There should be local health providers working to provide access and quality health care to low income Filipino immigrant populations. Provisions should be provided to the Filipino community with linguistically and culturally appropriate services.

In addition Chen (2008) says that information dissemination about several programs and services such as children's health, nutrition, health education, and HIV testing and breast cancer support. Such programs report a stronger sense of hope and control over their endeavors to stop some behaviors. The federal government should organize some forums is involved in advocating at state and federal government levels for policies that deal with health care access the need for more health care data and cultural and linguistic competence. Ho-Asjoe (2009) says that even as the government strives to explain health related behaviors and environments it is important to facilitate intervention design based on health related behaviors and environments. 

The government should use a comprehensive cross-cultural assessment as the first step in Filipino health care access. Sanchez & Gaw (2007) noted that "health care evaluation should include an immigration history, socioeconomic beginning and regional orientation, tracing the chronology of events leading to the need for health care." Another strategy is the use of visual cues and written words to facilitate understanding. Filipinos should be encouraged to accept pharmacotherapy through close affiliation with the psychiatrist (Sanchez & Gaw, 2007).

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