tens of millions of American's are uninsured because of rising costs of healthcare. Eight million of those effected are children. Even families that do have coverage are still struggling to pay for high co-pays. As american's we have not put much into preventive healthcare and many go without these services such as cancer screenings and immunizations against flus. We instead take care of people once they are sick and sometimes that is to late. Barrack Obama's plan is to strenthen employer–based coverage, making insurance companies accountable and ensures patient choice of doctor and care without government interference.If you already have health insurance you can stay with your current plan and your costs will decrease. If you dont not have health care then you will be given options of affordable insurance. He wants to make the healthcare system work for people and buissness as a priority instead of insurance companies.
It is not right that Americans families are paying skyrocketing premiums while drug and insurance industries are enjoying record profits. These companies benefit most from the status quo and in many cases are the greatest obstacles to reform. The Obama-Biden plan will tackle needless waste and spiraling costs by increasing
competition in the insurance and drug markets.
Saturday, October 17, 2009
Friday, October 16, 2009
United States v. Other Dominate Countries
An argument made by Arizona's senator Jon Kyl states that if President Obama get their way healthcare in America will start to look like healthcare over seas. Is this really such a bad thing? They say that everyone will be insured however people will have to wait in long lines to receive care and when they are finally seen the care they receive won't be very good. What we would we rather have happen, wait in lines to receive care or avoid the lines and not receive the care at all. The question sounds simple and completely irrational. Of course people would rather wait in the line if they are sick to receive care then not receive it all. Many republicans fear that we will turn our health care system into one much like Canada or the British. The British have socialized medicine and the doctors are government employed, the citizens receive universal healthcare and yes there may be a few lines they wait in but everyone has the right to wait in them. In canada the government insures everybody directly and private insurance has virtually no role. These countries hold the healthcare that American's say that they want. Timely, quality care. Physicians feel free to practice medicine the way they want; companies get to concentrate on their lines of business, rather than develop expertise in managing health benefits. And of course everybody has insurance.
Nearly 45 million American's are uninsured. Healthcare is one of the top social and economic problems facing Americans today. The rising cost of medical care and health insurance is impacting the livelihood of many Americans in one way or another. The inability to pay for necessary medical care is no longer a problem affecting only the uninsured, but is increasingly becoming a problem for those with health insurance as well. Some statistics include:
-In 2007, nearly 50 million Americans did not have health insurance, while another 25 million were underinsured. (Source: Commonwealth Fund Biennial Health Insurance Survey 2007)
-The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent. (Source: Robert Wood Johnson Foundation)
-The total annual premium for a typical family health insurance plan offered by employers was $12,680 in 2008. (Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008)
-Healthcare expenditures in the United States exceed $2 trillion a year. (SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group;) In comparison, the federal budget is $3 trillion a year.
An individual who is underinsured is a somewhat general concept which can vary depending on individual circumstances. The researchers at the Commonwealth Fund, however, define the underinsured as “people who spent 10 percent or more of their income on medical expenses (or 5 percent if they were low income), or people who had deductibles that equaled at least 5 percent of the family annual income. Research show that the underinsured act much like those that are uninsured. Not visiting the doctors for routine checkups, don't fill perceptions. How do other countries handle this problem? Whether one looks at infant mortality, life expectancy, the number of physicians, hospital beds, medical errors or high out-of-pocket expenses, America underperforms to a shocking degree. Consequently, the World Health Organization (WHO) has ranked the United States 72nd of 191 countries for "level of health."
And it ranks 37th for "overall health system performance" -- just behind Costa Rica and Dominica and just ahead of Slovenia and Cuba, countries with a fraction of the economic wealth of the United States.
France and Italy, which have universal health care coverage for all their residents, even recent immigrants, were ranked first and second in the WHO listing. Most other European nations, who also have universal coverage for all, also were ranked near the top.
Yet despite this difference in performance between U.S. and European systems, somehow Europe manages to spend only a fraction of what the United States spends on health care.According to the WHO, the United States spends 16.5% of its GDP on health care, or about $6,100 per person. This compares to an average of 8.6% in European countries. France does it for far less, spending just $3,500 per person, or 10.7% of its economy.
The first overriding difference between U.S. and European healthcare systems is one of philosophy. The various European healthcare systems put people and their health before profits -- la santé d'abord, "health comes first," as the French are fond of saying.
It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive -- or running it as a for-profit commercial enterprise. It's no coincidence that, as the United States tries to grapple with soaring healthcare costs and lack of universal coverage, UnitedHealth Group CEO William McGuire received a staggering $124.8 million in compensation in 2005. He is just one of many grossly overcompensated kingpins of the U.S. healthcare industry.
U.S. healthcare corporations will spout platitudes about wanting to provide good service for their customers, but there's no escaping the bottom line that the CEOs of giant health corporations ultimately are accountable to one small group -- their stockholders.
1 - Many Americans are uninsured because they are too "rich" for Medicaid and too poor for insurance, right? So does that create a situation where there are people who would be better off not working, and getting welfare and medicaid?
2. If the United States does try to give universal healthcare to all its citizens what would the country suffer before the reform actually begins to help people?
Nearly 45 million American's are uninsured. Healthcare is one of the top social and economic problems facing Americans today. The rising cost of medical care and health insurance is impacting the livelihood of many Americans in one way or another. The inability to pay for necessary medical care is no longer a problem affecting only the uninsured, but is increasingly becoming a problem for those with health insurance as well. Some statistics include:
-In 2007, nearly 50 million Americans did not have health insurance, while another 25 million were underinsured. (Source: Commonwealth Fund Biennial Health Insurance Survey 2007)
-The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent. (Source: Robert Wood Johnson Foundation)
-The total annual premium for a typical family health insurance plan offered by employers was $12,680 in 2008. (Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008)
-Healthcare expenditures in the United States exceed $2 trillion a year. (SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group;) In comparison, the federal budget is $3 trillion a year.
An individual who is underinsured is a somewhat general concept which can vary depending on individual circumstances. The researchers at the Commonwealth Fund, however, define the underinsured as “people who spent 10 percent or more of their income on medical expenses (or 5 percent if they were low income), or people who had deductibles that equaled at least 5 percent of the family annual income. Research show that the underinsured act much like those that are uninsured. Not visiting the doctors for routine checkups, don't fill perceptions. How do other countries handle this problem? Whether one looks at infant mortality, life expectancy, the number of physicians, hospital beds, medical errors or high out-of-pocket expenses, America underperforms to a shocking degree. Consequently, the World Health Organization (WHO) has ranked the United States 72nd of 191 countries for "level of health."
And it ranks 37th for "overall health system performance" -- just behind Costa Rica and Dominica and just ahead of Slovenia and Cuba, countries with a fraction of the economic wealth of the United States.
France and Italy, which have universal health care coverage for all their residents, even recent immigrants, were ranked first and second in the WHO listing. Most other European nations, who also have universal coverage for all, also were ranked near the top.
Yet despite this difference in performance between U.S. and European systems, somehow Europe manages to spend only a fraction of what the United States spends on health care.According to the WHO, the United States spends 16.5% of its GDP on health care, or about $6,100 per person. This compares to an average of 8.6% in European countries. France does it for far less, spending just $3,500 per person, or 10.7% of its economy.
The first overriding difference between U.S. and European healthcare systems is one of philosophy. The various European healthcare systems put people and their health before profits -- la santé d'abord, "health comes first," as the French are fond of saying.
It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive -- or running it as a for-profit commercial enterprise. It's no coincidence that, as the United States tries to grapple with soaring healthcare costs and lack of universal coverage, UnitedHealth Group CEO William McGuire received a staggering $124.8 million in compensation in 2005. He is just one of many grossly overcompensated kingpins of the U.S. healthcare industry.
U.S. healthcare corporations will spout platitudes about wanting to provide good service for their customers, but there's no escaping the bottom line that the CEOs of giant health corporations ultimately are accountable to one small group -- their stockholders.
1 - Many Americans are uninsured because they are too "rich" for Medicaid and too poor for insurance, right? So does that create a situation where there are people who would be better off not working, and getting welfare and medicaid?
2. If the United States does try to give universal healthcare to all its citizens what would the country suffer before the reform actually begins to help people?
Thursday, October 15, 2009
Health Insurance between Women and Single Mothers
Health Insurance Within the Population of Women and Single Mothers
By: Lindsey Bloomberg
The issue concerning the population of women and mothers within the United States receiving health care and medical needs is an ongoing barrier within our society. From gender inequalities, to single mothers whose salaries meet standards of poverty and women lacking inadequate care has remained problematic. Demographics such as race, socio economic status, education, single-mothers and the elderly reflect the broad span of rising issues, associated within the realm of health care risks.
According to findings from the U.S News and World Report, a health insurance survey held by The Common Wealth Fund in 2007 discovered 7 out of 10 women who are either uninsured, under-insured, and/or can’t meet costs of medical bills. A major factor concerns gender equality, differences in salary and the number of woman deprived of certain jobs due to the fact that they are single mothers. The study reflects this gap with data that proves an overall 52% of women (over half the population) lack adequate health insurance compared to 30% of men also enduring the issue. Another valid concern is this recent data does not represent the population during this economic recession, where the statistics have fallen even lower. Data shows that those with incomes of $60,000 per year are unable to meet health care costs and the rate of poverty among unemployed single mothers consumes 28.3% of the U.S population (according to the Institute for Women Policy of Research).
This data equates to 64 million women just within the United States. It’s amazing to take into perspective that the richest country in the world still lacks the ability to supply sufficient access to medical needs. How is it that Americans are denied these basic needs, considering world wide poverty within countries who do not have access to medical care.
Factors that might improve the health care condition within the U.S suggest changes such as equal salaries among genders, improving training and education for women, subsidized health care and benefits (being paid for taking care of children when ill, flexibility being paid while on leave within the work place, etc)
Questions to Consider:
• Within this economic relapse what are the chances of the issues among health care improving; considering companies have cut budgets and increasing numbers of the population are being laid off?
• How does the increase of stress related to unemployment and difficult economic times negatively impact people’s health and wellness?
• While salary equality has been a long, ongoing socio-economic issue, when and how will women’s rights become adequately addressed? What are the chances of establishing law enforcements for equal gender pay?
• What are President Obama’s plans to address health care?
• During this current baby boom, how will the population of single mothers in poverty reduce? Or how will the population of single mothers with sufficient jobs improve?
• What other changes within the government could improve the state of this issue and status of those suffering medical costs?
By: Lindsey Bloomberg
The issue concerning the population of women and mothers within the United States receiving health care and medical needs is an ongoing barrier within our society. From gender inequalities, to single mothers whose salaries meet standards of poverty and women lacking inadequate care has remained problematic. Demographics such as race, socio economic status, education, single-mothers and the elderly reflect the broad span of rising issues, associated within the realm of health care risks.
According to findings from the U.S News and World Report, a health insurance survey held by The Common Wealth Fund in 2007 discovered 7 out of 10 women who are either uninsured, under-insured, and/or can’t meet costs of medical bills. A major factor concerns gender equality, differences in salary and the number of woman deprived of certain jobs due to the fact that they are single mothers. The study reflects this gap with data that proves an overall 52% of women (over half the population) lack adequate health insurance compared to 30% of men also enduring the issue. Another valid concern is this recent data does not represent the population during this economic recession, where the statistics have fallen even lower. Data shows that those with incomes of $60,000 per year are unable to meet health care costs and the rate of poverty among unemployed single mothers consumes 28.3% of the U.S population (according to the Institute for Women Policy of Research).
This data equates to 64 million women just within the United States. It’s amazing to take into perspective that the richest country in the world still lacks the ability to supply sufficient access to medical needs. How is it that Americans are denied these basic needs, considering world wide poverty within countries who do not have access to medical care.
Factors that might improve the health care condition within the U.S suggest changes such as equal salaries among genders, improving training and education for women, subsidized health care and benefits (being paid for taking care of children when ill, flexibility being paid while on leave within the work place, etc)
Questions to Consider:
• Within this economic relapse what are the chances of the issues among health care improving; considering companies have cut budgets and increasing numbers of the population are being laid off?
• How does the increase of stress related to unemployment and difficult economic times negatively impact people’s health and wellness?
• While salary equality has been a long, ongoing socio-economic issue, when and how will women’s rights become adequately addressed? What are the chances of establishing law enforcements for equal gender pay?
• What are President Obama’s plans to address health care?
• During this current baby boom, how will the population of single mothers in poverty reduce? Or how will the population of single mothers with sufficient jobs improve?
• What other changes within the government could improve the state of this issue and status of those suffering medical costs?
Health Insurance beyond the underpriveledged
A few points that I'd like to emphasize after reading the blog:
1) It's interesting that your group cited that for an average family the costs of health insurance can be around $13,000 a year. What's difficult to even comprehend right now is that even if the family was middle class -- and closer to $75,000 ... this is still just slightly under 1/4th of their income. I'm not sure if anybody has bought a house, or (much like the average american family) has more than two kids -- but bills stack up fast and can be costly. Morgages, loans, school bills -- in the span of a year many couples struggle with keeping the house updated (and not just cosmetically but even the necessities are expensive) a new roof, or water heater, or floor, or to spray for flees, or termites, for insects of any kind, or if you have to buy some kind of chemical because there's a problem with insects eating away all the greenery on your property -- many issues home-owners go through. Or if the family has animals, those bills become costly -- just life expenses in general are so high that who can afford health care without driving themselves insane, and putting a very high stress level on the family unit?
2) Beyond the underpriveleged I'd like people to look at options for post college students. I know that I'm nervous about graduating and what I'm going to do for healthcare when I do so. Usually post-graduates are nervous to negotiate salaries when they graduate, I'm thinking that maybe it would be better to negotiate benefits -- an option that might be smart to pose to prospective employers (if they aren't including healthcare benefits).
1) It's interesting that your group cited that for an average family the costs of health insurance can be around $13,000 a year. What's difficult to even comprehend right now is that even if the family was middle class -- and closer to $75,000 ... this is still just slightly under 1/4th of their income. I'm not sure if anybody has bought a house, or (much like the average american family) has more than two kids -- but bills stack up fast and can be costly. Morgages, loans, school bills -- in the span of a year many couples struggle with keeping the house updated (and not just cosmetically but even the necessities are expensive) a new roof, or water heater, or floor, or to spray for flees, or termites, for insects of any kind, or if you have to buy some kind of chemical because there's a problem with insects eating away all the greenery on your property -- many issues home-owners go through. Or if the family has animals, those bills become costly -- just life expenses in general are so high that who can afford health care without driving themselves insane, and putting a very high stress level on the family unit?
2) Beyond the underpriveleged I'd like people to look at options for post college students. I know that I'm nervous about graduating and what I'm going to do for healthcare when I do so. Usually post-graduates are nervous to negotiate salaries when they graduate, I'm thinking that maybe it would be better to negotiate benefits -- an option that might be smart to pose to prospective employers (if they aren't including healthcare benefits).
Minorities and Health care
Minorities have been getting the short end of the stick when it comes to most aspects in society. Health care seems to be no different. Usually referred to as “institutionalized racism” minorities access and quality of health care is a lot worse compared to the access and quality Caucasians.
Minorities are less likely to have health care. (As seen by the chart provided on Monday’s posting). This could be due to economic reasons, minorities are more likely to have low paying jobs and the low paying jobs do not provide health insurance for their workers.
Areas that have a high population of minorities usually be under served. Minority physicians are more likely to practice in minority communities. Yet, because of all of the institutionalized racism in the education system (e.x biases in testing) minorities are usually underrepresented. This leaves the control to white doctors, who usually have their practices in white communities. This causes minority issues to usually be ignored. For example billions of dollars are spent each year on health research bit only a small percentage of those funds are allocated to research on issues of particular importance to women and minorities, and to research by women and minority scientists (21.5% and .37%, respectively).
There are many discriminatory policies that happen when a minority is just being checked in a hospital. They usually have unequal access to emergency care, lack of community care; go to a clinic compared to a hospital or have a deposit requirement (http://academic.udayton.edu/health/07HumanRights/racial01c.htm). An example would be refusing Medicaid patients from treatment at certain hospitals or not providing translators for all of the languages needed. Or the fact that African Americans are less likely to get to get major tests done when complaining of certain symptoms compared to Caucasians.
Nevertheless the statistics speak for themselves. Minorities are more likely to be sick and suffer from a major disease compared to whites. Check out the two websites sited to see the numbers on the likely hood of minorities getting sick.
http://www.omhrc.gov/templates/browse.aspx?lvl=3&lvlid=23
http://www.omhrc.gov/templates/browse.aspx?lvl=3&lvlid=31
Here are some interesting articles to read that expand upon this idea.
Report finds minorities get poorer health care, http://archives.cnn.com/2002/HEALTH/03/20/race.healthcare/index.html
Minorities and health care what’s the real story
http://www.huffingtonpost.com/francesca-billersafran/minorities-and-health-car_b_275611.html
Sources I used
http://academic.udayton.edu/health/07HumanRights/racial01c.htm
www.omhrc.gov
Questions to consider:
-Do you think the health care system is another example of “White Privilege?” Why or Why not?
Minorities are less likely to have health care. (As seen by the chart provided on Monday’s posting). This could be due to economic reasons, minorities are more likely to have low paying jobs and the low paying jobs do not provide health insurance for their workers.
Areas that have a high population of minorities usually be under served. Minority physicians are more likely to practice in minority communities. Yet, because of all of the institutionalized racism in the education system (e.x biases in testing) minorities are usually underrepresented. This leaves the control to white doctors, who usually have their practices in white communities. This causes minority issues to usually be ignored. For example billions of dollars are spent each year on health research bit only a small percentage of those funds are allocated to research on issues of particular importance to women and minorities, and to research by women and minority scientists (21.5% and .37%, respectively).
There are many discriminatory policies that happen when a minority is just being checked in a hospital. They usually have unequal access to emergency care, lack of community care; go to a clinic compared to a hospital or have a deposit requirement (http://academic.udayton.edu/health/07HumanRights/racial01c.htm). An example would be refusing Medicaid patients from treatment at certain hospitals or not providing translators for all of the languages needed. Or the fact that African Americans are less likely to get to get major tests done when complaining of certain symptoms compared to Caucasians.
Nevertheless the statistics speak for themselves. Minorities are more likely to be sick and suffer from a major disease compared to whites. Check out the two websites sited to see the numbers on the likely hood of minorities getting sick.
http://www.omhrc.gov/templates/browse.aspx?lvl=3&lvlid=23
http://www.omhrc.gov/templates/browse.aspx?lvl=3&lvlid=31
Here are some interesting articles to read that expand upon this idea.
Report finds minorities get poorer health care, http://archives.cnn.com/2002/HEALTH/03/20/race.healthcare/index.html
Minorities and health care what’s the real story
http://www.huffingtonpost.com/francesca-billersafran/minorities-and-health-car_b_275611.html
Sources I used
http://academic.udayton.edu/health/07HumanRights/racial01c.htm
www.omhrc.gov
Questions to consider:
-Do you think the health care system is another example of “White Privilege?” Why or Why not?
Wednesday, October 14, 2009
Tuesday, October 13, 2009
Homeless Health care
Clearly, the United States values populations that hold power. The homeless community is powerless, and because of that their basic needs, even if they are a United States citizen, are flat out not being met. I found this article, about homeless and health care in England. Although community spoken of in the article is not of the U.S., the general issues among the homeless are exactly the same, regardless of location. For example, the cycle of mental illness that is a trend among most homeless families. The resource for this article was also The Health Reference Center Academic Infotrac, the link follows the article.
Health without a home: through user involvement, the QNI Homeless Health Initiative has identified key ways in which health care for homeless people needs to be improved.
Many community practitioners have homeless and insecurely housed patients on their caseload. Yet it is often difficult for them to meet the needs of this highly vulnerable group, due to a lack of support and of specialist knowledge and skills.
The Queen's Nursing Institute (QNI) Homeless Health Initiative (HHI) is funded by the Big Lottery Fund, and offers a way forward for practitioners through peer networking, information sharing and support, and professional training opportunities and resources. In order to ensure the input of homeless people in informing its work, the HHI commissioned the user involvement organisation Groundswell to research homeless people's experiences with health care. (1)
Multiple risk factors
There are an estimated 380 000 single homeless people (adults with no children) in England. (2) Homeless families (adults with children) in England include an estimated 116 000 homeless children. (3) Rough-sleeping is the most visible, extreme aspect of homelessness, but the vast majority of homeless people live in hostels, squats or bed and breakfasts, or in insecure conditions with friends or family.
Homelessness creates multiple risk factors to health, which almost inevitably deteriorates as a result of the prioritisation of immediate needs such as shelter, food and warmth. Health problems can severely affect homeless people's quality of life and limit their ability to access routes out of homelessness. Homeless people suffer significant inequalities in terms of both health and ability to access services.
People who are homeless experience significantly higher rates of health problems such as respiratory disorders, skin and dental problems, musculoskeletal problems and sexually transmitted diseases. Those sleeping rough have a rate of physical health problems two or three times greater than the general population's. (4) Homeless children are 'more likely to have a history of low birthweight, anaemia, dental decay and delayed immunizations ... to suffer accidents, injuries and burns', and the development of a substantial proportion of them is delayed (p463-4). (5)
Homeless children are up to four times more likely to experience mental health problems (6) and their parents are also more likely to experience them: 'Homeless mothers had a 49% prevalence rate of psychopathology and an 11% rate of contact with mental health services in the previous year' (p465). (5)
Indeed, mental health problems are a leading cause of homelessness--in a third of cases, losing a home is associated with mental health problems. (7) Homelessness can create mental health problems for the first time and exacerbate those that already exist. Mental health problems have been found to be eight times as high among hostel and bed and breakfast residents, and 11 times as high among people sleeping rough compared to the general population. (8) Many have multiple needs requiring appropriate health care.
Barriers to services
Homeless people frequently experience great difficulties in accessing the health care services that they need. They are 40 times more likely to not be registered with a GP and four times more likely to use accident and emergency (A&E) than the general population. (9)
Many mainstream providers lack knowledge on homeless people's health needs, impacting adversely on the care provided. There are examples of good practice, such as allowing homeless people to register with a GP using the surgery's address as their own and homelessness training for professionals, and there are a number of specialist services that offer a range of flexible, accessible services (including outreach). However, provision may be patchy, with a lack of specialist services in many areas and a lack of knowledge in generalist services.
Report findings
The Groundswell report (1) was commissioned with these issues in mind, along with the QNI's commitment to service user involvement. Focus groups with 25 homeless people were held in Grimsby, London and Gloucester, with professional facilitators who had personal experiences of homelessness. Recommendations to improve health care for homeless people were based on the findings (see Box 1).
The most important factor in a health service for the participants was the people, since what mattered was 'respect, good people, tolerance, care, compassion, friendly, no general rudeness.' Specific health issues varied according to circumstances--for example, rough sleepers identified cleanliness, safety and foot care.
Barriers to accessing services included waiting times, insufficient time with professionals, opening times and a lack of information. Service users expressed diverse experiences of staff attitudes, but frequently perceived these to be more negative due to their being homeless:
I was homeless and [the GP] didn't want me around ... he's a lot better now I've got a stable address and all that, he treats me with respect.
Different problems with A&E were noted, including a perception that triage and security staff often had a negative "gate-keeping" role.
Around 38% stated that their first port of call for health care would be a 'one-stop shop'--centres offering homelessness services and health care--but this may have been because many participants were accessed via these kinds of services. In an emergency, most said they would go to A&E or dial '999'.
Some of the participants reported having previously been discharged from hospital onto the streets:
They didn't find me anywhere to live, even though they said they would if I've been discharged on the streets.
I was beaten up and had stitches. Two o'clock in the morning, they're throwing me out. The following day I was vomiting blood.
The positive experiences described by participants included being discharged with enough medication for a week. However, some hospitals may be unaware of the national guidance on hospital discharge for homeless people.
Practitioners' needs
Community practitioners are committed and highly skilled professionals, but caring for this vulnerable population--often with multiple health issues and sometimes chaotic lives--presents many challenges. This may include institutional barriers such as a lack of understanding of homeless health issues by providers. Like their clients, practitioners may also be unsupported and marginalised, sometimes feeling stigmatised and undervalued. There can be insufficient support, resources and appropriate supervision, and restricted career opportunities. (10)
Inadequate understanding and prioritisation of homeless health issues in local health economies means that homeless services are often vulnerable to cuts. In addition, practitioners working in generic services may be unsupported in addressing homeless people's health needs. If there is no analysis of homeless people's local health needs, these can remain 'invisible'.
Imagine being a doctor in an emergency room, and you have a homeless patient to release, they are in bad shape, and you know they have no home. Would it be unethical to let him or her stay the night in a warm bed? It absolutely would, but at the same time if in the situation, I would imagine having a hard time releasing that person because of their circumstances. However, special treatment can not be given to every patient so where is the line drawn?
Health without a home: through user involvement, the QNI Homeless Health Initiative has identified key ways in which health care for homeless people needs to be improved.
Many community practitioners have homeless and insecurely housed patients on their caseload. Yet it is often difficult for them to meet the needs of this highly vulnerable group, due to a lack of support and of specialist knowledge and skills.
The Queen's Nursing Institute (QNI) Homeless Health Initiative (HHI) is funded by the Big Lottery Fund, and offers a way forward for practitioners through peer networking, information sharing and support, and professional training opportunities and resources. In order to ensure the input of homeless people in informing its work, the HHI commissioned the user involvement organisation Groundswell to research homeless people's experiences with health care. (1)
Multiple risk factors
There are an estimated 380 000 single homeless people (adults with no children) in England. (2) Homeless families (adults with children) in England include an estimated 116 000 homeless children. (3) Rough-sleeping is the most visible, extreme aspect of homelessness, but the vast majority of homeless people live in hostels, squats or bed and breakfasts, or in insecure conditions with friends or family.
Homelessness creates multiple risk factors to health, which almost inevitably deteriorates as a result of the prioritisation of immediate needs such as shelter, food and warmth. Health problems can severely affect homeless people's quality of life and limit their ability to access routes out of homelessness. Homeless people suffer significant inequalities in terms of both health and ability to access services.
People who are homeless experience significantly higher rates of health problems such as respiratory disorders, skin and dental problems, musculoskeletal problems and sexually transmitted diseases. Those sleeping rough have a rate of physical health problems two or three times greater than the general population's. (4) Homeless children are 'more likely to have a history of low birthweight, anaemia, dental decay and delayed immunizations ... to suffer accidents, injuries and burns', and the development of a substantial proportion of them is delayed (p463-4). (5)
Homeless children are up to four times more likely to experience mental health problems (6) and their parents are also more likely to experience them: 'Homeless mothers had a 49% prevalence rate of psychopathology and an 11% rate of contact with mental health services in the previous year' (p465). (5)
Indeed, mental health problems are a leading cause of homelessness--in a third of cases, losing a home is associated with mental health problems. (7) Homelessness can create mental health problems for the first time and exacerbate those that already exist. Mental health problems have been found to be eight times as high among hostel and bed and breakfast residents, and 11 times as high among people sleeping rough compared to the general population. (8) Many have multiple needs requiring appropriate health care.
Barriers to services
Homeless people frequently experience great difficulties in accessing the health care services that they need. They are 40 times more likely to not be registered with a GP and four times more likely to use accident and emergency (A&E) than the general population. (9)
Many mainstream providers lack knowledge on homeless people's health needs, impacting adversely on the care provided. There are examples of good practice, such as allowing homeless people to register with a GP using the surgery's address as their own and homelessness training for professionals, and there are a number of specialist services that offer a range of flexible, accessible services (including outreach). However, provision may be patchy, with a lack of specialist services in many areas and a lack of knowledge in generalist services.
Report findings
The Groundswell report (1) was commissioned with these issues in mind, along with the QNI's commitment to service user involvement. Focus groups with 25 homeless people were held in Grimsby, London and Gloucester, with professional facilitators who had personal experiences of homelessness. Recommendations to improve health care for homeless people were based on the findings (see Box 1).
The most important factor in a health service for the participants was the people, since what mattered was 'respect, good people, tolerance, care, compassion, friendly, no general rudeness.' Specific health issues varied according to circumstances--for example, rough sleepers identified cleanliness, safety and foot care.
Barriers to accessing services included waiting times, insufficient time with professionals, opening times and a lack of information. Service users expressed diverse experiences of staff attitudes, but frequently perceived these to be more negative due to their being homeless:
I was homeless and [the GP] didn't want me around ... he's a lot better now I've got a stable address and all that, he treats me with respect.
Different problems with A&E were noted, including a perception that triage and security staff often had a negative "gate-keeping" role.
Around 38% stated that their first port of call for health care would be a 'one-stop shop'--centres offering homelessness services and health care--but this may have been because many participants were accessed via these kinds of services. In an emergency, most said they would go to A&E or dial '999'.
Some of the participants reported having previously been discharged from hospital onto the streets:
They didn't find me anywhere to live, even though they said they would if I've been discharged on the streets.
I was beaten up and had stitches. Two o'clock in the morning, they're throwing me out. The following day I was vomiting blood.
The positive experiences described by participants included being discharged with enough medication for a week. However, some hospitals may be unaware of the national guidance on hospital discharge for homeless people.
Practitioners' needs
Community practitioners are committed and highly skilled professionals, but caring for this vulnerable population--often with multiple health issues and sometimes chaotic lives--presents many challenges. This may include institutional barriers such as a lack of understanding of homeless health issues by providers. Like their clients, practitioners may also be unsupported and marginalised, sometimes feeling stigmatised and undervalued. There can be insufficient support, resources and appropriate supervision, and restricted career opportunities. (10)
Inadequate understanding and prioritisation of homeless health issues in local health economies means that homeless services are often vulnerable to cuts. In addition, practitioners working in generic services may be unsupported in addressing homeless people's health needs. If there is no analysis of homeless people's local health needs, these can remain 'invisible'.
Imagine being a doctor in an emergency room, and you have a homeless patient to release, they are in bad shape, and you know they have no home. Would it be unethical to let him or her stay the night in a warm bed? It absolutely would, but at the same time if in the situation, I would imagine having a hard time releasing that person because of their circumstances. However, special treatment can not be given to every patient so where is the line drawn?
Homelessness and Healthcare
An important population to consider when looking at the health care system is the homeless. For whichever reason a person is homeless, regardless of their mental stability, economic status, or education health care is a basic need for everyone, and as a country we are excluding many people from our current health care laws.
There are many faults to the current health care system, and many reasons why populations, like the homeless, are not taken into account. But, on a positive note, let's take a look at a hopeful article about a homeless health care facility right here in Boston. The article is taken from the Health Reference Center Academic Infotrac. The site is below the article.
Jean Yawkey Place in Boston is operated by the Boston Health Care for the Homeless Program (BHCHP), founded in 1985 by Jim O'Connell, MD, to provide behavioral and primary healthcare to people who are homeless. Although the building originally housed the city's morgue, a pathology lab, and a ambulance garage, Jean Yawkey Place offers centralized and dignified surroundings for Boston's homeless population.
The 4-story, 77,000-square-foot building was constructed in 1933. The renovation, designed by Steffian Bradley Architects, began in December 2006 and took approximately 18 months. The projects total cost was $42 million. The Yawkey Foundation contributed $5 million.
Jean Yawkey Place provides people who are homeless access to a broad range of healthcare services, including behavioral healthcare, under one roof. It houses a primary care clinic with 14 exam rooms, a dental clinic with 5 operatories, outpatient mental health services, family services, a pharmacy, BHCHP's research department, program and administrative offices, and 104 beds for respite care.
"The behavioral health services are integrated within the [primary care] clinic and offered within the exam rooms on an as-needed basis" explains Teresa Wilson, AIA, a principal at Steffian Bradley Architects. "This model of care allows for full flexibility in the use of each exam room ... rather than sending the patient to a different area for behavioral health services "
The main entrance opens into the lobby of the Cary W. Akins Pavilion, which features large bay windows to create a sense of spaciousness and to bring in more light. The dental clinic and pharmacy are located directly off the lobby, as is a large conference room with sliding doors. The lobby uses woods, a light color palette, and a low ceiling to create a warm and pleasant atmosphere. The primary care clinic and other services on the first floor serve walk-ins and those with appointments.
A separate historic lobby serves as a staff entrance and as a gathering place for fund-raisers. Original wood detailing was preserved, and the lobby's original colors were reproduced. Windows added along an exterior wall for extra light were designed and placed to keep with the building's original style.
The second floor contains the activity room, staff and client dining rooms, administrative offices, and a large solarium constructed on the original building's roof. The solarium provides clients with a sun-lighted indoor place to relax and socialize, or they can step out onto the deck to gather at tables and benches, The deck has a green screen of ivy that obscures a fence. Stephen W. Van Ness, AIA, principal-in-charge at Steffian Bradley Architects, notes that the solarium "was really meant to be the heart and soul of the facility itself. ... The idea was to bring as much natural light into that space as possible," Jean Yawkey Place's third and fourth floors, named the Barbara Mclnnis House, include the same services as those provided on the first floor. They also are provided on these upper floors to ease traffic and to ensure those using the respite beds on these floors receive optimum care. The third and fourth floors use natural materials and neutral colors, The corridor's flooring has bold patterns, and varied ceiling heights reduce the perception of the hallways' length.
Each respite room has four-to six-bed arrangements and each floor has an isolation room. Each room has a recessed "front door" with a wall light and personalized tackboard to provide a sense of home, as well as shared bathrooms, a TV for each roommate, and large windows.
YAWKEY PLACE Boston, Massachusetts
what are people's thoughts about a facility like this? Would we be helping the homeless population by creating more of these places?
There are many faults to the current health care system, and many reasons why populations, like the homeless, are not taken into account. But, on a positive note, let's take a look at a hopeful article about a homeless health care facility right here in Boston. The article is taken from the Health Reference Center Academic Infotrac. The site is below the article.
Jean Yawkey Place in Boston is operated by the Boston Health Care for the Homeless Program (BHCHP), founded in 1985 by Jim O'Connell, MD, to provide behavioral and primary healthcare to people who are homeless. Although the building originally housed the city's morgue, a pathology lab, and a ambulance garage, Jean Yawkey Place offers centralized and dignified surroundings for Boston's homeless population.
The 4-story, 77,000-square-foot building was constructed in 1933. The renovation, designed by Steffian Bradley Architects, began in December 2006 and took approximately 18 months. The projects total cost was $42 million. The Yawkey Foundation contributed $5 million.
Jean Yawkey Place provides people who are homeless access to a broad range of healthcare services, including behavioral healthcare, under one roof. It houses a primary care clinic with 14 exam rooms, a dental clinic with 5 operatories, outpatient mental health services, family services, a pharmacy, BHCHP's research department, program and administrative offices, and 104 beds for respite care.
"The behavioral health services are integrated within the [primary care] clinic and offered within the exam rooms on an as-needed basis" explains Teresa Wilson, AIA, a principal at Steffian Bradley Architects. "This model of care allows for full flexibility in the use of each exam room ... rather than sending the patient to a different area for behavioral health services "
The main entrance opens into the lobby of the Cary W. Akins Pavilion, which features large bay windows to create a sense of spaciousness and to bring in more light. The dental clinic and pharmacy are located directly off the lobby, as is a large conference room with sliding doors. The lobby uses woods, a light color palette, and a low ceiling to create a warm and pleasant atmosphere. The primary care clinic and other services on the first floor serve walk-ins and those with appointments.
A separate historic lobby serves as a staff entrance and as a gathering place for fund-raisers. Original wood detailing was preserved, and the lobby's original colors were reproduced. Windows added along an exterior wall for extra light were designed and placed to keep with the building's original style.
The second floor contains the activity room, staff and client dining rooms, administrative offices, and a large solarium constructed on the original building's roof. The solarium provides clients with a sun-lighted indoor place to relax and socialize, or they can step out onto the deck to gather at tables and benches, The deck has a green screen of ivy that obscures a fence. Stephen W. Van Ness, AIA, principal-in-charge at Steffian Bradley Architects, notes that the solarium "was really meant to be the heart and soul of the facility itself. ... The idea was to bring as much natural light into that space as possible," Jean Yawkey Place's third and fourth floors, named the Barbara Mclnnis House, include the same services as those provided on the first floor. They also are provided on these upper floors to ease traffic and to ensure those using the respite beds on these floors receive optimum care. The third and fourth floors use natural materials and neutral colors, The corridor's flooring has bold patterns, and varied ceiling heights reduce the perception of the hallways' length.
Each respite room has four-to six-bed arrangements and each floor has an isolation room. Each room has a recessed "front door" with a wall light and personalized tackboard to provide a sense of home, as well as shared bathrooms, a TV for each roommate, and large windows.
YAWKEY PLACE Boston, Massachusetts
what are people's thoughts about a facility like this? Would we be helping the homeless population by creating more of these places?
Monday, October 12, 2009
Question to consider
According to the charts around 18% of people living in the U.S are uninsured. That is a large amount of people who do not have money for things such as check-ups for preventative care, operations, etc. Overall the most important question is how do you feel about the health system in America????
-[Group 1]
-[Group 1]
Healthcare in America
Lindsey Bloomberg
Lisa Rodriguez
Alli Shortt
Alyssa Wood
A controversial issue in today’s society is health care. In whatever context, health care affects the family structure, and socioeconomic class in the United States. We decided to focus on health care for our blog research because America is in a health care crisis and President Obama is presenting a plan for universal health care in our country. From race, gender, ethnicity, sexual orientation, economic status to immigration the current health care system affects all demographics. Lacking power, and education the lower class population usually suffers the most from our current health care system.
According to figures from the New York Times, over 45 million Americans go without health insurance, and that statistic is growing every year. Although programs like Medicare provide for some elderly and lower class citizens, there are still many populations who are not covered. (Social Problems By William Kornelum)
28% of middle income families (income being 30,000-75,000) struggle to afford health insurance. Health care costs in the United States are higher than any developed country. The total annual premium for a typical family health insurance plan is approximately 13,000 a year (in 2008). (www.healthcareproblems.org/health-care-statisics.htm)
The National Coalition on Health Care provided National statistics regarding how many Americans are uninsured.
How Many Americans Are Uninsured?
• Several studies estimate the number of uninsured Americans. According to the U.S. Census Bureau, nearly 47 million Americans, or 20 percent of the population under the age of 65, were without health insurance in 2008, their latest data available.1
• The Agency for Healthcare Research and Quality, using the Medical Expenditure Panel Survey (MEPS) estimated that the percentage of uninsured Americans under age 65 represented 27 percent of the population. According to the MEPS data, nearly 54 million Americans under the age of 65 were uninsured in the first-half of 2007. 2
• A recent study shows that based on the effects of the recession alone (not job loss), it is projected that nearly seven (7) million Americans will lose their health insurance coverage between 2008 and 2010. 3 Urban Institute researchers estimate that if unemployment reaches 10 percent, another six (6) million Americans will lose their health insurance coverage. Taking these numbers together, it is conceivable that by next year, 57 to 60 million Americans will be uninsured.
• The Urban Institute estimates that under a worse case scenario, 66 million Americans will be uninsured by 2019. 4
• Nearly 90 million people – about one-third of the population below the age of 65 spent a portion of either 2007 or 2008 without health coverage.
The following charts are from the United States Department of Health and Human Services. They provide a snapshot of who is insuring those with health insurance, ages of the uninsured, and also ethnicity and the uninsured. The blog is not allowing the images to be shown directly on the blog.
The website is:
http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm#The
Lisa Rodriguez
Alli Shortt
Alyssa Wood
A controversial issue in today’s society is health care. In whatever context, health care affects the family structure, and socioeconomic class in the United States. We decided to focus on health care for our blog research because America is in a health care crisis and President Obama is presenting a plan for universal health care in our country. From race, gender, ethnicity, sexual orientation, economic status to immigration the current health care system affects all demographics. Lacking power, and education the lower class population usually suffers the most from our current health care system.
According to figures from the New York Times, over 45 million Americans go without health insurance, and that statistic is growing every year. Although programs like Medicare provide for some elderly and lower class citizens, there are still many populations who are not covered. (Social Problems By William Kornelum)
28% of middle income families (income being 30,000-75,000) struggle to afford health insurance. Health care costs in the United States are higher than any developed country. The total annual premium for a typical family health insurance plan is approximately 13,000 a year (in 2008). (www.healthcareproblems.org/health-care-statisics.htm)
The National Coalition on Health Care provided National statistics regarding how many Americans are uninsured.
How Many Americans Are Uninsured?
• Several studies estimate the number of uninsured Americans. According to the U.S. Census Bureau, nearly 47 million Americans, or 20 percent of the population under the age of 65, were without health insurance in 2008, their latest data available.1
• The Agency for Healthcare Research and Quality, using the Medical Expenditure Panel Survey (MEPS) estimated that the percentage of uninsured Americans under age 65 represented 27 percent of the population. According to the MEPS data, nearly 54 million Americans under the age of 65 were uninsured in the first-half of 2007. 2
• A recent study shows that based on the effects of the recession alone (not job loss), it is projected that nearly seven (7) million Americans will lose their health insurance coverage between 2008 and 2010. 3 Urban Institute researchers estimate that if unemployment reaches 10 percent, another six (6) million Americans will lose their health insurance coverage. Taking these numbers together, it is conceivable that by next year, 57 to 60 million Americans will be uninsured.
• The Urban Institute estimates that under a worse case scenario, 66 million Americans will be uninsured by 2019. 4
• Nearly 90 million people – about one-third of the population below the age of 65 spent a portion of either 2007 or 2008 without health coverage.
The following charts are from the United States Department of Health and Human Services. They provide a snapshot of who is insuring those with health insurance, ages of the uninsured, and also ethnicity and the uninsured. The blog is not allowing the images to be shown directly on the blog.
The website is:
http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm#The
Subscribe to:
Posts (Atom)
