Barriers and Disparities in Health Care

Barriers and Disparities in Health Care

Barriers and Disparities in Health Care

Since the 1970's, the health care system in the United States has attempted a few strategies to help curtail the high costs of health care. During this time of drastic change in health care, reimbursements for services and providers continue to decline while costs for these same services continue to increase at a staggeringly rate. This paper will discuss, in short, some barriers and disparities related to these changes and address current means of reimbursement.

Health Maintenance Organizations (HMO) and preferred provider organizations (PPO) are two types of managed health care used in the United States. An HMO plan provides its' members with a group of contracted physicians. These physicians provide medical care at a discounted rate negotiated by the insurance provider. Since the medical services are prepaid, members are restricted to receiving in network care. A PPO plan differs slightly and allows members larger networks and access to out of network doctors, though using out of network services increases members out of pocket expenses.

Barriers and disparities related to HMO's and PPO's vary slightly, though both exhibit their limitations to solving our current health care dilemma. You'll pay more out-of-pocket for a PPO compared with an HMO, especially if you see out-of-network doctors. But PPOs tend to have larger networks and they make it easier to get out-of-network care. Until recently, PPOs hadn't focused on measuring and improving quality of care as much as HMOs had. They score lower on average than HMOs in the NCQA rankings of health plans reported this year, in part because they currently collect data differently. With an HMO you will have more limited options for out-of-network care than with a PPO. But you will generally pay less out-of-pocket, have less paper work, and have more coordination of your care that's overseen by your primary-care doctor. HMOs also emphasize measuring and improving quality of care ("PPOs vs. HMOs", 2011)

The Patient Protection and Affordable Care Act of 2010 (ACA) contains many embedded exclusions and California, being a largely multicultural state, there may be an increase in health insurance disparities. Many unaddressed issues regarding inequities of racial and cultural nature impair their abilities to access health care remain. A second disparity is the relationship to citizenship status. Non-citizens without a green card despite health care reforms remain uninsured. Barriers that exist are more concentrated on income, knowledge deficits of the different programs available and paperwork (Lavarreda et al., 2012).

Medicare covers the elderly, age 65 and over, and any person with a federally recognized disability. Many recipients of Medicare receive dual coverage since many hospital and outpatient services come with costing sharing. ACA removes the cost sharing of certain preventative services, which in turns removes barriers experienced by this population. Eligibility to quality for Medicare is based on the ability to have worked 10 ten years in the United States and paying toward Medicare payroll tax or self-employment tax (Lavarreda et al., 2012, p. 67). Another barrier foreseen is the ability of persons being English proficient and the presumed need for more interpreter services as the current Medi-Cal population ages. A limited barrier is the prescription drug coverage. New plans