Amponsah 1Uninsured Immigrants and Healthcare in the United States SDSU COLLEGE OF NURSING N495: DIRECTED STUDIES IN NURSING SOCIAL JUSTICE PAPER BY: JENNIFER AMPONSAH February 27th, 2012
Amponsah 2 Uninsured Immigrants and Healthcare in the United StatesIntroduction Imagine walking into a healthcare setting or facility and receiving no care because youhave no health insurance and the healthcare facility cannot afford to treat without any cost.United States as one of the major immigrant-accepting countries, has observed a rapid increasein its foreign-born population. There are several barriers that affect immigrants or foreign bornindividuals. These barriers include but not limited to unfamiliarity with the United States healthcare system, language barriers (limited English or English not as primary language). In additionsto theses barriers, foreign-born individuals face greater difficulties in obtaining the necessaryfinancial means to cover health care costs than do naturalized or native-born citizens. Mostimportantly, non-citizen immigrants are much less likely to have employment-based privatehealth insurance, as many are not allowed to work in the United States and, even if they haveemployment, are less likely to have jobs with benefits. This leads to uninsured among theimmigrants population. Uninsured contribute to a large portion of inadequate care, which causesa major issue in social justice. Many healthcare settings do not have adequate funds to treat apatient free of charge which makes it makes difficult to give patients the best care possible.Therefore the purpose of this paper is to discuss the social justice issues that arise withinadequate healthcare among uninsured immigrants, the consequences, possible outcomes, andinterventions to improve this problem.Antecedents and Historical context Immigrants are one of the fastest growing populations in the United States for the pastdecade. In 2005, about 12% of the US population (36 million) consisted of foreign-bornindividuals, and that figure had doubled since 1970 (Sungkyu & Sunha, 2009). The United States
Amponsah 3receives an average of 104,000 foreigners a day, and about 1.2 million new immigrants each year(Lebrun & Dubay, 2010). As the immigrant population continues to grow, the uninsuredpopulations also continue to increase in the United States. Forty-eight million people or one-sixthof United States population is uninsured (Becker, 2007). Fourteen million of those uninsured arebelow the poverty threshold level. These individuals are eligible for Medicaid, but they havefailed to apply for Medicaid, which might be due to lack of knowledge regarding availableresources. Eleven million of these uninsured populations have declined health insurance offeredto them by their employers because they elected not to spend the portion of their pay required tocover the employee contribution. In addition, eighteen million of the uninsured have a householdincome of more than $50,000 per year; and, interestingly, 9 million of those have a householdincome of greater than $75,000 per year. Moreover, 9.7 million of the uninsured are illegalimmigrants (Sataloff, 2010). Healthcare is one of the most important needs of humans, and dueto this everyone deserves the right to equal healthcare no matter their origin, age, race, religion,or economic status, which then creates a social justice issue.Potential or actual consequences “The uninsured in the United States are systematically less likely than the insured toreceive effective, safe, and timely care” (Becker, 2007). Inadequate healthcare among uninsuredimmigrant violate many issues of social justice, causing many ethical dilemmas. This issue ison the rise as healthcare cost continues to rise and the immigrant population continues to grow inthe United States. Due to this the uninsured does not receive safe and effective care. Forexample, healthcare providers will spend more time providing effective care to their insuredpatient so that patients will come back to them when are having any problems. Also, healthcare
Amponsah 4providers are more likely to see their insured patients first during the day because this is wheretheir source of income comes from The United States health system fosters a structured approach of containment toward theuninsured, that’s not only marginalizes them but it keeps the problem of the uninsured in checkby discouraging people from using health care services(Becker, 2007). I personally, find this tobe absolutely true, because the cost of care for uninsured population in the United States ishigher than the care of insured populations. For example, the cost of colonoscopy for insuredperson is around $1700 to 2000, but the cost of the same procedure for uninsured person isaround $3,000. Due to this, most immigrants fail to seek healthcare when necessary and wait tillthe illness get worst because they cannot afford the cost. The uninsured immigrants are also more likely to delay needed care (Becker, 2007). Forexample, uninsured immigrants’ pregnant women will not seek prenatal care until they are faralong during their pregnancy because they cannot afford the care and might not see theimportance of prenatal care. Cost of healthcare being one of the biggest issues affecting manypeople; discourages most individuals including uninsured immigrants not to seek health whenneeded. Research also proves that the uninsured are also less likely to receive timely preventiveand outpatient care and are more likely to be hospitalizing for avoidable health problems(Rowland & Shartzer, 2008). This means uninsured immigrants are less likely to receivepreventative care such as cholesterol testing and cancer screening, Pap smear, annual breastexams, colonoscopy, and etc. For example, one might have Pap smear all her life until sheexperiences the symptoms of cervical cancer. Or one might not check their cholesterol levels
Amponsah 5until he or she experience chest pain, but due to uninsured and the cost of emergency roomservice, he or she might delay care until they code. Also insured immigrants are more like to be incompliance with medication regimens.This is because for instance, if you were not treated fairly at the healthcare facility, would youlike to follow that persons instructions? I know I wouldn’t because the person did not treat mewell, how like do they care about my wellbeing, and how beneficial will their prescribedmedication help me. Due to these consequences, uninsured immigrant has decrease in lifeexpectancy than insured US citizens.Professional behaviors and Outcomes One issue of social justice that is violated is beneficence. Beneficence is action that isdone for the benefit of others. Beneficent actions can be taken to help prevent or remove harmsor to simply improve the situation of others. Medical personnel need to refrain from causingharm and do the best to help patients (Patronis Jones, 2007). Uninsured do not benefit patients,and in fact, can do more harm to the patient. Patient’s cares are being denied because the patientcannot afford the care, and hospitals or healthcare facilities cannot afford to treat patients for nocost. A way to improve beneficence when it comes to uninsured immigrants and healthcare oran outcome would be health promotion, and education. Community nurses or all nurses can teachthe immigrants or the community regarding importance of health insurance, and how it benefitsthem. Also all healthcare facilities can provide a teaching session for nurses on how to provideequal care to patients regardless their status, nationality, and status. Also facilities can put signson units regarding nurses advocating for their uninsured patient to facilitate equality inhealthcare.
Amponsah 6 Non-maleficence can be another ethical dilemma related to uninsured and healthcare.Non-maleficence means to “do no harm.” Physicians and nurses must refrain from providingineffective treatments or acting with malice toward patients. There are many factors of insuredwhich violate the “do not harm” definition (Patronis Jones, 2007). This ethical dilemma isviolated when healthcare providers do not provide adequate care for their patients, or when anurse fails to advocate for the uninsured patients. To do no harm to patients, a physician or nurseshould equal and quality care at all times even if the patient is uninsured. A possible outcome forthis ethical dilemma would be all nursing schools should introduce their student to other culturesor other people from different countries. For example, SDSU gives its students an opportunity towork with the refugee population in Sioux Falls. I think this provides great opportunity for thestudents to learn and understand people with other backgrounds so that if they come across suchpopulation in their work force, they will be able to provide them with adequate care. This issomething that I personally have learned and will put this into practice. To do justice is another ethical dilemma that is violated greatly when dealing withuninsured. Every patient is to be treated fairly whether white or colored, citizen or immigrant,uninsured or insured. Not only are patients who are uninsured have disadvantaged whenreceiving care in the US, but also inadequate healthcare appears to be one of the social justiceissues facing many uninsured immigrants in the United States. To ensure justice in healthcare, apossible outcome should be that, all healthcare providers must provide equal and adequate careto all their patients, even if they are uninsured and foreign born citizens. This can be done byproviding them with a translator if language is a barrier, spend quality time with them, and treatthem like you would treat your insured U.S citizen patients. Providing equality care amonguninsured immigrant will lead to positive health outcomes, such as compliance with medication
Amponsah 7regimens, lower levels of disability, decreases in health care costs, improved control of chronicconditions, and increases in patient satisfaction with care (Sungkyu & Sunha, 2009).Conclusion In conclusion, inadequate healthcare appears to be one of the social justice issues facingmany Uninsured immigrants in the United States today. Providing equality care amonguninsured immigrant by all healthcare providers will lead to positive health outcomes, such ascompliance with medication regimens, lower levels of disability, decreases in health care costs,improved control of chronic conditions, and increases in patient satisfaction with care which willhelp eliminate this social justice issue.
Amponsah 8 ReferencesBecker, G. (2007). The Uninsured and the Politics of Containment in U.S. Health Care. Medical Anthropology, 26(4), 299-321. doi:10.1080/01459740701619806Lebrun, L. A., & Dubay, L. C. (2010). Access to Primary and Preventive Care among Foreign- Born Adults in Canada and the United States Access to Primary and Preventive Care. Health Services Research, 45(6p1), 1693-1719. doi:10.1111/j.1475-6773.2010.01163.xPatronis Jones, R.A. (2007). Nursing leadership and management: Theories, Processes and Practice. Philadelphia, PA: F.A. Davis Company.Rowland, D., & Shartzer, A. (2008). Americas Uninsured: The Statistics and Back Story. Journal Of Law, Medicine & Ethics, 36(4), 618-628. doi:10.1111/j.1748- 720X.2008.00316.xSataloff, R. T. (2010, February). Healthcare for the uninsured: A simpler, cheaper, faster, better solution. ENT: Ear, Nose & Throat Journal. pp. 52-55.Sungkyu, L., & Sunha, C. (2009). Disparities in access to health care among non-citizens in the United States. Health Sociology Review, 18(3), 307-320