Unique health care needs of special populations
Poor access to health care is a problem for many special populations, and the reasons spans across the global community. According to Anderson, Rice and Kominski (2001) access to care is often assessed by existence of regular medical care and coverage of services, as well as by an absence of delays and barriers to care. Having a regular source of medical care is recognize as important for the general population, as well as for those with various chronic diseases (Anderson, Rice & Kominski, 2001 p.236). The poor, elderly, women, children and HIV/AIDS group are the most vulnerable groups in the world. The World Health Organization (WHO) indicate the next two decades will see dramatic changes in the health needs of the world’s populations with non-communicable diseases, mental illness, infectious diseases and chronic illness as leading causes of disability. Increases in the older population by up to 300% are expected in many developing countries; in addition, HIV/AIDS will continue to be a major cause of disability and death. These changes require a very different approach to health sector policy and health care services among the special populations of the world (WHO, 2006)
Special population needs
According to WHO, there were 390 million people aged over 65 years recorded in 1998, and this figure is estimated to double in 2025. With advances in medicine and prolonged life expectancy, the proportion of older people will continue to rise worldwide (WHO, 2006). Unfortunately fragile health and mobility, neglect and abuse are factors that increase the vulnerability of elder women and men. Al-Nasir and Al-Haddad (1999) suggest as the overall number of elderly people increase there is a corresponding rise in the number of older persons with disabilities. Such disabilities may be social, physical, mental or psychological. Data from the U.S. have estimated that 9.5 million, non-institutionalized individuals, experience difficulty in performing basic activities, such as walking, self-care and home management activities (Al-Nasir & AL-Haddad, 1999).
The elderly population and there needs has an enormous implications for health care system across the global. The financial infrastructure of nations must be prepared to accommodate the coming influx of elderly patient. According to Fried and Gaydos (2002) the aging population, has put enormous pressure on the Japanese health care system. The Japan’s has a unique fund for the elderly know as the Roken system. The Roken system is a pooling fund which attempts to distribute the burden of paying for geriatric care for all Japanese. Established in 1983, the pooling fund covers those who are more than 70 years old and bedridden people over 65 years old. The fund pools contributions from all insurance schemes. Seventy percent of medical costs for the elderly are covered by contributions from health insurance societies for company employees and national health insurance schemes and the government shoulders the remaining 30 percent (Fried and Gaydos, 2002 p. 251). One draw back to the Roken system is when the number of workers paying into the pooling fund is lower than the proportion of elderly people seeking assistance the system may not be sustainable.
In the U.S. the rapid growth of the elderly will put new stains on the financial resources of Medicare. Many older people who on fix incomes or limited financial resources may need a system as the Japanese Roken system, where health care is covered by contributions from health insurance companies or a universal social insurance scheme. The Medicare program has broad public support because it offers health security to many older and disabled people. Longest, Rakich and Darr (2000) suggest the need for a long-term approach to program financing, improved benefits and protections for people with low incomes remains an important issue to address. Medicare is facing the challenge of financing and managing health care for the growing number of Americans who will rely on this program for health insurance protection (Longest, Rakich and Darr, 2000). In the future the increasing growth of the elderly may pressure the government to set policies that resemble a cost sharing between private insurance and Medicare.
According to Kates, Jennifer, Dorian, Richard, Crowely, Jeffers, Summers and Todd (2002) more than 60 million people have been infected with HIV worldwide, 20 million have died. HIV is now the leading cause of death in Africa and the fourth leading cause of death worldwide. Most of the impact has been felt in the developing world. Children and women are increasingly at risk. In addition, it is estimated that more than 40 million children will have lost one or both parents to HIV/AIDS by 2010 and these children will also be at increased risk for HIV (Kates, et. al, 2002). Access to treatment and available drugs are some of the unique health care needs facing the world HIV/AIDS population.
Fried and Gaydos (2002) indicate Cuba incidence of HIV/AIDS cases remains very low, although it is increasing as Cuba opens more to tourism and external contracts. Cuba once had a policy of quarantining for all HIV-positive cases. Pressures from international bodies such as the United Nations and many large nongovernmental agencies, Cuba now has a voluntary quarantine after medically recommended stay in a residency for eighth weeks. All newly identified people with HIV are also expected to spend at least eight weeks in a sanatorium (Fried & Gaydos, 2002). Cuba’s health system is funded primarily by the national budget through indirect taxation and duties. Cubans are expected to pay for all drugs for outpatient treatment. Access to health care treatment and services for HIV/AIDS patient therefore is very limited.
In the U.S. even a voluntary quarantine of newly HIV diagnosed patient would be a social injustice. As HIV progress in the U.S. individuals experience disability and unemployment due to the illness. Many HIV/AIDS patients rely on public entitlements and private disability programs for income maintenance and health care benefits. Medicaid and Medicare are the primary payers for individuals who are disabled. Anderson, Rice and Kominski (2001) suggest the lack of insurance and underinsure can represent formidable financial barriers to treatment for HIV/AIDS. Persons with HIV/AIDS are more likely than the general population to be uninsured or to have Medicaid insurance. Unlike Cuba in the U.S. AIDS medication is available to HIV/AIDS patient however not all medications are covered by insurance (Anderson, Rice & Kominski, 2001).
The financial burden of HIV infection increasing in communities is a financial burden on health care providers and public payers. The reliance on an infinite source of public funds for people with HIV/AIDS is in dout. Cuba is a communist country which developed a process of governmental quarantine for the HIV/AIDS population. The U.S. method of moving the HIV/AIDS patients into managed Medicaid health plans is a better process in which patient care is managed for the purpose of reducing the cost of treatment.
While gender affects the health of both men and women, WHO places special emphasis on the health consequences of discrimination against women that exist in nearly every culture. Powerful barriers including poverty, unequal power relationships between men and women, and lack of education prevent millions of women around the world from having access to health care and from attaining and maintaining the best possible health (WHO, 2006).
Anderson, Rice and Kominski (2001) indicate in Israel the waves of immigration in the early twentieth century sparked the establishment of networks of community welfare and health organizations. The sick fund model of health provision has persisted in Israel to this day. Although the 1994 National Health Insurance (NHI) Law made all sick funds regulated subcontractors of the state, thereby providing health care services to the country’s residents under government regulation (Anderson, Rice & Kominski, 2001). The system has been developed through voluntary sick funds, not for profit institutions, and the state. Israeli health system stem from organized social arrangements in which the government is responsible for the health of its citizens. The state has an active role in the development and financing of health care services that extend into the private sectors.
In the U.S the entrepreneurial system is more concern with the cost and the profit involve in providing health care for individuals. The Israel NHI is a system of collaborative efforts on subcontractors of the government. The process of subcontracting allows the government to oversea the implementation of health care activities through out the country. In the U.S. entrepreneurial system subcontracting by the government would give too much control over the health care system. The Israel system can not be applied readily to the U.S. health care system because there are no true national mandates that can be applied to an entrepreneurial system. Anderson, Rice and Kominski (2001) indicate in the U.S. individuals or employers may purchase private health insurance. Approximately 63 percent of Americans had private health insurance between 1977 and 1999. Of those with private insurance, 58 percent obtained health insurance through their employer, and 5 percent purchased insurance individually. Private health insurance companies may operate as for profit or not for profit organizations (Anderson, Rice & Kominski, 2001). Private health insurance organization with in the U.S. would fight against a system such as Israel NIH. The NIH is a allows Israel to regulate the health care system by subcontracting this type of system would cut the profit margin of private health insurance companies in the U.S.
Rising health insurance costs and high numbers of uninsured citizens has generated a public interest in national laws that would provide access to care for special populations. When evaluating Non-US health care concepts there is no one systems that guarantee universal access to health care for all. The national health care policy in the U.S. has evolved incrementally over the decade. Access to care has generally depended on insurance coverage that is implemented privately or publicly. With the increase needs of special populations the U.S. will have to establish policies that allow the collaboration between private as well as public entities to secure access for those in need.
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