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

Literature Review

Changes in the health care industry have had serious implications in the delivery of health care. Health care delivery rose from 5.9% in 1965 to 11.1% of the nation’s gross national product (Headen, 1990). The increased cost of health care has resulted in fewer employers being able to cover their staff, which adds to the growing number of uninsured in the United States. A study done on the health care experiences and preferences of the uninsured found that uninsured workers believe that having insurance would give them a wide range of options and will help them get better services. When deciding on health care, they use an improvised cost analysis so that they sometimes have to choose between food and medicine and often choose the one for which the need is most urgent. Few uninsured workers have used Medicaid. They often neglect their condition until it becomes worse and they can no longer ignore it. They tend to perceive their health as good if they do not have serious illnesses (Loon, 2002). In another study done on the health care problems of homeless adults, it showed that due to poverty and their environment, homeless adults are vulnerable to a number of medical conditions. In a national survey, 13% of the homeless have reported that they are in poor physical condition. Some senior homeless adults fall through the cracks of the Medicaid system. They have a very high rate of both acute and chronic health problems.

Homeless adults also experience a large increase in mental disorders, particularly a high incidence of depression and dementia. Living in the streets, they experience trauma due to mugging, robbing, and rape. Many of the homeless adults resort to alcohol and drugs, adding to their health problems. Because of exposure on the streets, some get hypothermia and frostbite. Bad nutrition and exposure to unhygienic and poor conditions leads to a weak immune system and an inability to cope with diseases. Because of the unhygienic conditions in which they live, they are also at a higher risk for communicable diseases. Poverty along with the lack of any kind of public or private health insurance coverage makes it very hard for them to get health care access (Bottomley, 2001). This study shows the need to have a vulnerable domain in addition to a traditional domain as subjects in the vulnerable domain, like the homeless, face problems due to the conditions of their environment. Unless we study the variables in the vulnerable domain, we cannot predict solutions to their problems.

In a report presented by the Institute of Medicine to the Congress proposing universal health care by 2010, 18,000 Americans die each year due to the lack of coverage. This raises the question: How long can we ignore 43 million uninsured in the United States, which if not dealt with, will result in huge economic costs (Perkins, 2004)?