NHS FPX 6008 Assessment 1 Identifying A Local Health Care Economic Issue

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Assessment 1: Identifying a Local Health Care Economic Issue
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Student Name
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Capella University
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Course Name
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Nov 8, 2023
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Identifying a Local Health Care Economic Issue
Access to healthcare and sufficient health insurance coverage is a critical healthcare concern
impacting individuals, healthcare providers, and organizations. Insufficient health insurance
coverage is a significant economic challenge affecting individuals' access to timely and quality
healthcare services (World Health Organization, 2019). This report will focus on the economic
issue of inadequate health insurance coverage and its implications for healthcare delivery.
Reasons for Inadequate Healthcare Insurance
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The healthcare industry has grappled with the issue of inadequate health insurance coverage
for numerous years. This topic was chosen due to its widespread impact on the entire
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healthcare system, affecting patients, healthcare providers, and organizations. In 2019, the
Centers for Disease Control and Prevention (CDC) reported that 28.9 million individuals in the
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United States lacked health insurance, and this number likely increased due to the COVID-19
pandemic (Centers for Disease Control and Prevention, 2021).
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Description of Inadequate Health Insurance Coverage
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One community particularly vulnerable to this issue is low-income individuals and families. San
Francisco General Hospital (SFGH) caters to a substantial number of uninsured and
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underinsured patients (San Francisco Department of Public Health, 2021). According to a report
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by the San Francisco Department of Public Health (2021), in 2019, 10% of San Francisco
residents lacked health insurance coverage, and an additional 9% faced difficulties accessing
care despite having coverage. These individuals are more likely to postpone or forego
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necessary medical care due to cost, leading to worsened health outcomes.

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The Impacts of Inadequate Health Insurance Coverage

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The impact of inadequate health insurance coverage on San Francisco General Hospital
(SFGH) is evident in its patient population, where a majority are uninsured or covered by
Medicaid. This situation poses challenges in accessing care and strains the hospital’s financial
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resources due to uncompensated care. To tackle this issue, SFGH has implemented various
programs, including financial counseling services and a charity care program for eligible patients
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(San Francisco Department of Public Health, 2021).

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Rationale for Healthcare Insurance

The rationale for inadequate healthcare insurance coverage is rooted in the fundamental
principle that access to quality healthcare is a basic human right. Access to necessary medical
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care is crucial for maintaining good health and well-being, and lack of access can result in
worsened health outcomes and financial hardship (Cohen et al., 2020).
In the United States, inadequate healthcare insurance coverage is driven by factors such as the
high cost of healthcare services, the complexity of the insurance system, and the limited
availability of affordable insurance options (Cohen et al., 2020).
Reason for Selecting Healthcare Insurance
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Personal experiences as a healthcare provider and a community member affected by
inadequate healthcare insurance coverage have influenced the choice of this issue. Observing
the negative effects of inadequate insurance coverage on patients’ ability to access necessary
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medical care and the financial strain it places on healthcare organizations has motivated this
selection. As a member of the impacted community, I recognize the barriers individuals and
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families face in accessing care due to financial constraints and believe that access to quality
healthcare is a basic human right that should not result in financial hardship.
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Significant Impacts of Healthcare Insurance on Diverse Groups
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Inadequate healthcare insurance coverage significantly impacts my work as a healthcare
provider, my organization, my colleagues, and my community. The issue disproportionately
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affects diverse and lower socio-economic groups, exacerbating health disparities (Tolbert et al.,
2020).
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As a healthcare provider, inadequate insurance coverage negatively impacts the quality of care
for my patients. Patients may skip necessary medical care due to cost, leading to worsened
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health outcomes. Patients from diverse or lower socio-economic groups are particularly
vulnerable to these negative effects due to social determinants of health, such as poverty and
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lack of access to healthy food options (Phuong et al., 2022).

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The impact of inadequate insurance coverage on my organization and colleagues can also be
significant. The organization may face financial strain due to uncompensated care, which can
impact its ability to provide quality care and invest in new technologies or infrastructure
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(Camilleri & Diebold, 2019). This can lead to workforce challenges, such as understaffing or
staff burnout.
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In my community, inadequate healthcare insurance coverage significantly impacts diverse and

lower socio-economic groups. According to a report by the Kaiser Family Foundation, uninsured
rates are higher among people of color and individuals with lower incomes (Kaiser Family
Foundation, 2020).
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Gap Contributing to Inadequate Healthcare Insurance
The gap contributing to inadequate healthcare insurance coverage is the lack of comprehensive
and affordable health insurance options, especially for people from diverse or lower
socio-economic groups. This is due to high healthcare costs, limited employer-sponsored
coverage, and restrictive eligibility criteria for public insurance programs (Kaiser Family
Foundation, 2020). Political challenges to the Affordable Care Act have also created uncertainty
around future healthcare coverage and access. Addressing these gaps in coverage is essential
to promote health equity and improve health outcomes for all individuals (Odeny, 2021).
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Policy Solutions
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Addressing this gap will require comprehensive policy solutions to improve access to affordable
and comprehensive health insurance coverage for all individuals, regardless of race, income, or
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pre-existing health conditions (Odeny, 2021). This may include expanding Medicaid eligibility,
strengthening the ACA marketplace, and implementing policies to address the underlying social
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determinants of health that contribute to health disparities and insurance coverage gaps.
Evidence to Support the Policy Solutions

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Evidence suggests that policy solutions to improve access to health insurance can significantly
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impact health outcomes and financial stability for individuals and healthcare organizations. For
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example, a study of Medicaid expansion in Michigan found that the expansion was associated
with increased access to care, improved health outcomes, and reduced financial strain for
individuals and healthcare providers (McInerney et al., 2020).
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Conclusion
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Inadequate healthcare insurance coverage is a critical economic issue that affects individuals,
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healthcare organizations, and communities, particularly those from diverse or lower

socio-economic groups. The high cost of healthcare and restrictive eligibility criteria for public
insurance programs contribute to gaps in health insurance coverage, resulting in poor health
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outcomes and financial burdens for individuals and healthcare organizations.

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References
Camilleri, S., & Diebold, J. (2019). Hospital uncompensated care and patient experience: An
instrumental variable approach. Health services research, 54(3), 603–612.
https://doi.org/10.1111/1475-6773.13111
Centers for Disease Control and Prevention (CDC). (2021). Health insurance coverage: Early
release of estimates from the National Health Interview Survey, 2019.
https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202102-508.pdf
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Cohen, S., Cohen, N., & Gabbay, E. (2020). Paternalism and certitude. Bioethics, 34(5),
478-482. https://doi.org/10.1111/bioe.12700
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Kaiser Family Foundation. (2020). Key facts about the uninsured population. Kff.org.
https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
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McInerney, M., Winecoff, R., Ayyagari, P., Simon, K., & Bundorf, M. K. (2020). ACA medicaid
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expansion associated with increased medicaid participation and improved health among
near-elderly: Evidence from the health and retirement study. INQUIRY
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: The Journal of health care organization, provision, and financing, 57, 004695802093522.
https://doi.org/10.1177/0046958020935229
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Odeny, B. (2021). Closing the health equity gap: A role for implementation science? PLOS
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Medicine, 18(9), e1003762. https://doi.org/10.1371/journal.pmed.1003762

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Phuong, J., Riches, N. O., Madlock‐Brown, C., Duran, D., Calzoni, L., Espinoza, J. C., Datta,
G., Kavuluru, R., Weiskopf, N. G., Ward‐Caviness, C. K., & Lin, A. Y. (2022). Social
determinants of health factors for gene–environment COVID‐19 Research: Challenges and
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opportunities. Advanced genetics, 3(2), 2100056. https://doi.org/10.1002/ggn2.202100056

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San Francisco Department of Public Health. (2022). San Francisco Health Plan 2022 Quality
improvement program description & work plan. Sfhp.org.
https://www.sfhp.org/wp-content/files/providers/QIEval/QIPlan.pdf
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Tolbert, J., Orgera, K., & Damico, A. (2020, December 19). Key facts about the uninsured
population. Kaiser Family Foundation.
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https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
World Health Organization. (2019, July 16). Universal health coverage. Who.int.
https://www.who.int/health-topics/universal-health-coverage#tab=tab_
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Assessment 1: Identifying a Local Health Care Economic Issue

Reasons for Inadequate Healthcare Insurance

necessary medical care due to cost, leading to worsened health outcomes.

The Impacts of Inadequate Health Insurance Coverage

(San Francisco Department of Public Health, 2021).

Rationale for Healthcare Insurance

Reason for Selecting Healthcare Insurance

lack of access to healthy food options (Phuong et al., 2022).

In my community, inadequate healthcare insurance coverage significantly impacts diverse and

Evidence to Support the Policy Solutions

healthcare organizations, and communities, particularly those from diverse or lower

outcomes and financial burdens for individuals and healthcare organizations.

Medicine, 18(9), e1003762. https://doi.org/10.1371/journal.pmed.1003762

opportunities. Advanced genetics, 3(2), 2100056. https://doi.org/10.1002/ggn2.202100056

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