In the controversial environment that surrounds health care spending today, vulnerable populations invariably get sidelined. These populations constitute a significant, growing proportion of our overall population and economy and remain ignored only at our own peril. However, finding effective ways to ensure their access to quality health care has been elusive in our existing political and socioeconomic climate.
Vulnerable Populations … What Are They?
First, what are “vulnerable populations”? Shi and Stevens define them as “those at greater risk for poor health status and health care access.” These populations “generally include racial and ethnic minorities, low SES (socioeconomic status) populations, and those without adequate potential access to care.” The uninsured fall into the last category.
Historically, this has been the case. In a 1971 Lancet paper entitled “The Inverse Care Law,” Hart proposed that access to quality medical care is least available to populations that need it the most. The stronger the market forces, the more this law dominates, usually at the expense of equity and social justice.
The Biggest Stumbling Block
In recent times, health care costs have spiraled out of control, growing by 91% from 2000 to 2011. Health care spending has been growing at approximately double the rate of the per capita income for decades now.
With health spending accounting for almost one-fifth of the nation’s GDP today, we seem be losing the financial wiggle-room to effectively fund health care options for vulnerable populations.
Initiatives to Eliminate Disparities
Despite the unfavorable economic and political environment, the government has taken some initiatives in recent times to reduce disparities in health care access. These include the Health and Human Services Disparities Action Plan (2011) and the deeply controversial Affordable Care Act (ACA or “Obamacare”, 2013).
A recent Gallup poll reveals that the ACA has lowered the uninsured rate for all U.S. adults down to 11.0% in 2016 from a peak of almost 17.1% in 2013. The most remarkable shift happened for families making less than $36,000 annually, where the uninsured rate dropped dramatically from 30.7% to 20.4%. The uninsured rates for Hispanics and blacks also dropped by 10.9 and 8.6 percent points, respectively.
Progress hasn’t come without its cost. The increased investment in health care coverage has resulted in a big uptick in health spending. About $3.2 trillion was spent on health care in 2015, outpacing the previous year by 5.8%, recording the fastest pace of growth since 2007.
Is There a Solution?
We live in times of political upheaval compounded by the government’s struggle with an ever-growing budget deficit and major, long-delayed infrastructure-related expenses. In that environment, much can still be accomplished to provide healthcare solutions for the vulnerable through organizational initiatives at the grassroots level.
One option involves attracting private entities to participate in important public projects through increasingly popular Public Private Partnerships (P3). The benefits relate to a lot more than just funding, since private companies can bring the business, financial planning, and subject matter expertise that public organizations may lack. For example, private and publicly funded medical homes that provide comprehensive and continuous care, and substitute for expensive short-term alternatives such as emergency rooms, have been shown to reduce overall costs and improve outcomes, especially for vulnerable populations.
A California 3-billion dollar experiment, in collaboration with the federal government, recognizes that it takes more than insurance to ensure the health of vulnerable populations. In plans that involve the cooperative effort from 18 counties, California is targeting to improve the quality and efficiency of care provided to the homeless, ex-prisoners, substance abusers, mental health patients, and people suffering from multiple chronic illnesses. The projects blend physical and mental care with social service to provide “whole person care.”
These initiatives are showing the way for others to align themselves with the goal of health equity and improved patient health outcomes by serving the under-served, despite the political and socio-economic odds.