Understanding the Health Care Needs of the Medically Indigent of Grayson County

Introduction

The main objective of this research is to understand the major problems faced by the uninsured residents of Grayson County in getting medical care. The results from the research will have significant policy implications on understanding the barriers to health care for the medically indigent population of Grayson County. According to a report by the Kaiser Commission (Kaiser Family Foundation, 2004), nearly 49 million people in the United States lack health insurance. Texas was identified as having the highest number of uninsured people in the United States. Nearly 20% of the population in Texas lacks coverage. More than half of the uninsured population lack coverage for a year or longer. The report also found that adults aged 19 to 34 are most likely to be uninsured and to be uninsured over longer periods. Race and ethnicity are also important factors in who is uninsured. Hispanics are three times more likely to be uninsured for periods of 12 months or more. The report states that the longer people remain uninsured, the harder it becomes for them to get access to care. People who lack coverage for a long time might not have a usual source of care, making it more difficult for them to get needed health care. Over the years, the rural health policy in the United States has changed. During the 1940s through the 1960s, policy initiatives were based on getting more health care resources to the people—public and private insurance, hospitals, health clinics, doctors, and nurses. As a result, this period saw an expansion of the health care infrastructure increasing access to the rural areas. From the 1970s throughout the 1980s, policies were aimed at bringing people to the resources and creating large centralized health care facilities. From the early 1990s to the present, health care policies were aimed at creating integrated managed health care systems and controlling the costs of health care (Mueller, 2001).

Several methodologies and instruments are used in conducting rural health care research. States have used several criteria in deciding what constitutes rural. Total number of residents, distance from a major metropolitan area, population density, and land use are some of the criteria used. (Loue & Morgenstern, 2001) Seasonal migration and lack of access to remote areas make it difficult to collect data. Several techniques are used to assess health care need and availability. Physician-to-population ratio compares the number of physicians to the size of the population. One critique of this method is that it does not take into account that people get care outside the county. The needs-based approach estimates the occurrence of relevant diseases and compares it to physician hours needed to prevent or detect the disease. The demand-based approach relies on past service utilization for the particular disease to understand the demand for care (Loue & Morgenstern, 2001).