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Assessment 1: Identifying a Local Health Care Economic Issue

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Student Name

Capella University

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Course Name

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Prof Name
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FEB 23, 2024
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Identifying a Local Healthcare Economic Challenge
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Access to healthcare and sufficient health insurance coverage remains a pressing concern in
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the healthcare landscape, affecting individuals, healthcare providers, and organizations alike.
The economic strain caused by inadequate health insurance coverage poses a significant
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barrier to accessing timely and quality healthcare services (World Health Organization, 2019).
This report aims to explore the economic implications of insufficient health insurance coverage
and its impact on healthcare delivery.
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Underlying Causes of Inadequate Health Insurance

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The issue of inadequate health insurance coverage has persisted in the healthcare sector for
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years, with far-reaching effects across the healthcare spectrum, impacting patients, providers,
and institutions alike. In 2019, the Centers for Disease Control and Prevention (CDC) reported
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that 28.9 million individuals in the United States lacked health insurance, a number likely
exacerbated by the COVID-19 pandemic (Centers for Disease Control and Prevention, 2021).

Describing Inadequate Health Insurance Coverage

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A particularly vulnerable demographic affected by this issue is low-income individuals and

families, with San Francisco General Hospital (SFGH) serving as a notable example. SFGH
caters to a significant number of uninsured and underinsured patients, as highlighted by the San
Francisco Department of Public Health's 2019 report, which indicated that 10% of residents

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lacked health insurance coverage, while an additional 9% faced challenges in accessing care
despite having coverage. These individuals often delay or forego necessary medical treatment
due to financial constraints, resulting in exacerbated health outcomes.

Implications of Inadequate Health Insurance Coverage

The impact of inadequate health insurance coverage on San Francisco General Hospital
(SFGH) is evident through its patient demographics, predominantly comprising uninsured or
Medicaid-covered individuals. This situation presents challenges in accessing care and strains

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the hospital’s financial resources due to uncompensated care. In response, SFGH has
implemented various initiatives, including financial counseling services and a charity care

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program for eligible patients (San Francisco Department of Public Health, 2021).

Justification for Healthcare Insurance

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The rationale behind inadequate healthcare insurance coverage stems from the fundamental

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belief that access to quality healthcare is a basic human right. Lack of access not only leads to
worsened health outcomes but also plunges individuals into financial hardship (Cohen et al.,
2020). In the United States, factors such as exorbitant healthcare costs, complexities in the
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insurance system, and limited affordable insurance options contribute to the issue (Cohen et al.,
2020).
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Personal Motivation for Selecting Healthcare Insurance
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Personal experiences as a healthcare provider and community member influenced the selection
of this issue. Witnessing firsthand the adverse effects of inadequate insurance coverage on
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patients’ access to healthcare and the financial strain it imposes on healthcare organizations
fueled this decision. As a member of the affected community, I advocate for access to quality
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healthcare without incurring financial hardship.

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Impact of Healthcare Insurance on Diverse Groups

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Inadequate healthcare insurance coverage disproportionately affects diverse and lower

socio-economic groups, exacerbating existing health disparities (Tolbert et al., 2020). As a
healthcare provider, I observe how inadequate insurance coverage compromises the quality of
care for patients, particularly those from diverse or lower socio-economic backgrounds, who are
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more susceptible to adverse health outcomes due to social determinants of health.

Addressing the Gap in Healthcare Insurance

The gap contributing to inadequate healthcare insurance coverage lies in the absence of
comprehensive and affordable health insurance options, especially for marginalized groups.
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High healthcare costs, limited employer-sponsored coverage, and stringent eligibility criteria for
public insurance programs exacerbate this gap. Political challenges to healthcare legislation
further compound the issue (Kaiser Family Foundation, 2020). Bridging this divide necessitates
comprehensive policy interventions to promote health equity and improve health outcomes for
all individuals (Odeny, 2021).

Policy Recommendations

Comprehensive policy solutions are imperative to enhance access to affordable and

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comprehensive health insurance coverage for all individuals, regardless of race, income, or
health status (Odeny, 2021). This may involve expanding Medicaid eligibility, strengthening the

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ACA marketplace, and addressing underlying social determinants of health to mitigate health
disparities and coverage gaps.

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Supporting Evidence for Policy Solutions

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Research indicates that policy interventions to enhance access to health insurance can
significantly influence health outcomes and financial stability for individuals and healthcare
organizations. For instance, a study on Medicaid expansion in Michigan demonstrated
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increased access to care, improved health outcomes, and reduced financial strain for both
individuals and healthcare providers (McInerney et al., 2020).
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Conclusion
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Inadequate healthcare insurance coverage emerges as a critical economic challenge impacting

individuals, healthcare organizations, and communities, particularly those from marginalized
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backgrounds. The high cost of healthcare services and restrictive eligibility criteria for insurance
programs perpetuate coverage gaps, resulting in adverse health outcomes and financial
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burdens. Addressing these disparities demands concerted efforts through comprehensive policy
interventions to ensure equitable access to quality healthcare for all.
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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

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Centers for Disease Control and Prevention (CDC). (2021). Health insurance coverage: Early
release of estimates from the National Health Interview Survey, 2019.

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https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202102-508.pdf

Cohen, S., Cohen, N., & Gabbay, E. (2020). Paternalism and certitude. Bioethics, 34(5),

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478-482. https://doi.org/10.1111/bioe.12700

Kaiser Family Foundation. (2020). Key facts about the uninsured population. Kff.org.

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https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

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.
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https://doi.org/10.1177/0046958020935229

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.
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

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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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