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Poverty considerably influences the accessibility of healthcare not only in the United States but also globally. According to Cooper (2019), about 30 million Americans still do not have an insurance policy despite increasing health insurance registration in the United States. Most people without insurance cover are the less privileged or marginalized communities, including the Hispanics, African Americans, and American Indians. Consequently, it is essential to investigate the primary ethical and cultural factors that escalate the healthcare inaccessibility problem. One of the research questions necessary to evaluate this issue is “How do ethical theories apply to the issue?” Another critical research question worth exploring is “Which cultural values and norms influence the problem?” These research questions help capture the general elements of the care accessibility and need upgrading to be detailed and specific. “How do ethical theories such as utilitarian and deontology apply to the access to care?” “What is the role of cultural values and norms in influencing the dynamics of the access to care problem?” Essentially, these improved research questions could help develop essential insights that guide developing practical solutions.
Ethical theories play an indispensable role in identifying and creating awareness of healthcare sector’s moral challenges, thus contributing to a sound and constructive dialogue. The problem of access to care emanates from an array of factors, including poverty, insufficient healthcare facilities and infrastructure, the lack of political goodwill, language barriers, and lack of health insurance. Thus, ethical models assists examine these underlying aspects to understand why the healthcare industry fails to share a similar moral outlook across different societies. According to Chukwuneke and Ezenwugo (2022), the utilitarian ethical theory proposes that outcomes define what is wrong and right. The most ethical decision often results in the greatest good for all. In the United States, the federal government enacted the Affordable Care Act (ACA) under President Obama to increase accessibility, especially among the poverty-stricken communities. This program has yielded positive results by increasing insurance coverage. According to Neiman et al. (2021), the number of insured people in America rose from 84% in 2010 to 91.4% in 2020. According to the utilitarian theory, this positive trajectory demonstrates the federal government’s commitment to promoting the common good to all residents.
Nevertheless, it is significant to note that some individuals are yet to purchase insurance plans. Deductively, 8.6% of the American population does not have an insurance policy. The question arising from this situation is, “Who is to blame for this failure to achieve the 100% registration?” Possibly, the government could have set aside funds to acquire insurance covers for the less privileged or marginalized people who could not afford them. The uninsured may also have no free will to acquire the insurance covers, thus inspiring the government to ignore them and focus on fulfilling other necessities such as education. According to Chokshi (2018), accessing healthcare is both a government initiative and a personal commitment. The greatest good advocated by the utilitarian model must be mutual. Notwithstanding, Cooper (2019) argues that ACA had gaps that led to conflicts between employers, insurance firms, and employees. Such disputes can also explain the failure to attain 100% insurance coverage. It is significant for the federal government and other involved stakeholders to have constructive discussions and address the existing ethical dilemmas to increase insurance coverage and improve access to care.
On its part, the deontology model places the responsibility on the individuals rather than on action outcomes. It necessitates absolute adherence to obligations, rules, and duties related to healthcare (Chukwuneke & Ezenwugo, 2022). In the lens of this theory, individuals should ensure that they look for healthcare services based on the existing laws. The government’s role is to invest in the healthcare industry, equipping it with the necessary human capital and other medical appliances. It is irrational to expect the government to force a person to access healthcare, as it is a personal duty. According to Chokshi (2018), individuals who are unwilling to take their roles sometimes augment the access to care problem. Regardless of their social and financial status, Americans should abide by the federal government’s regulations on insurance policy under ACA. If every stakeholder complied with the Act since the beginning, the entire American population could be presently insured. However, strictly applying the deontological ideology in healthcare could result in a conflict of interest among equally entitled people that may be challenging or downright impossible to resolve.
In exploring and answering the second research question, cultural values and norms are critical in influencing the dynamics revolving around access to care. All cultures adopt various systems that dictate health beliefs and explain the causes of diseases and their cure. Cultural relevance influences the extent to which individuals accept the use of the available medication information and their willingness to utilize it. For example, western developed societies such as Germany and the United States perceive illnesses as natural scientific occurrences (Cooper, 2019). Such civilizations recommend medical treatments that use sophisticated technologies to diagnose and treat diseases. Other communities believe that illnesses arise from supernatural phenomena and prefer to use prayers and other divine interventions to combat the presumed disfavor of the godly forces. A study involving adult Cambodians characterized by minimal formal education exhibited that they tried to comply with medical therapy based on their inherent understanding of functioning of their bodies and medicines (Degrie et al., 2017). The study demonstrated that cultural issues play an indispensable role in influencing access to care and patient compliance to treatment guidelines.
Fundamentally, various cultural elements, including family, religion, gender roles, and beliefs, affect the healthcare decision, irrespective of the people’s social status in the society. For instance, Pacific Islanders and Asians depend considerably on their extended families (Levin-Zamir et al., 2017). People from these groups can postpone the access to care to honor family interests. As a result, the American healthcare sector has failed to meet its anticipated standards due to these beliefs that sometimes discourage access to care. As a way of life, religion also creates obstacles to access to care and typical treatments. According to Degrie et al. (2017), Jews living in America abstain from particular types of food due to their religious and cultural beliefs. This self-restraint leads to dietary preferences that may be deficient in some crucial nutrients resulting in preventable illnesses. Healthcare professionals need to be conscious of these diverse cultural perspectives to offer patient and cultural-centered care.
Gender roles also influence the access to care, mainly among the marginalized communities or less privileged communities. Levin-Zamir et al. (2017) hypothesize that most civilizations have a strong attachment to their cultures because they think their beliefs and values unite them. In this regard, different genders within some societies often have diverse perceptions concerning medical treatments. Females may prefer to receive less invasive medications to make them comfortable and evade other necessary but demanding treatments. In other instances, gender roles may hinder treatment due to decision-making power. In the Hispanic population, old family members command considerable respect such that there are often consulted in critical matters involving illnesses and health. According to Degrie et al. (2017), there are several fatalistic viewpoints shared by Hispanic patients relating to God’s divine punishment, resulting in a preference for home remedies over hospital treatments. Such personal discrimination and egocentric decisions adversely hurt the overall wellness of American society.
Ethical theories and cultural values help understand diverse perceptions that influence the accessibility of care among less privileged people and marginalized communities. These models generate critical insights relating to what is morally right and wrong in promoting a healthy society. For example, the utilitarian theory emphasizes the pursuit of the greatest good for all residents, irrespective of their social or economic status. On its part, the deontological approach places the responsibility on people rather than the outcome of particular health action. It is a personal duty to access care and observe other healthcare regulations. Significantly, cross-cultural disparities exist within different cultures and affect individuals’ attitudes towards medical care. For instance, Hispanics depend on older relatives and family members to decide on access to care. Although poverty influences healthcare accessibility due to financial constraints, cultural beliefs also inspire people to favor home remedies over hospital treatments. Healthcare professionals need to understand the cultural traditions of their patients to offer services that align with their beliefs and norms. Therefore, culturally-oriented care remains an integral approach to increasing access to healthcare services.
References
Chokshi, D. A. (2018). Income, poverty, and health inequality. Jama, 319(13), 1312-1313. Web.
Chukwuneke, F., & Ezenwugo, A. (2022). Deontology vs. utilitarianism: Understanding the basis for the moral theories in medicine. International Journal of Medicine and Health Development, 27(1), 19-29. Web.
Cooper, R. B. (2019). Poverty and the myths of health care reform. Johns Hopkins University Press.
Degrie, L., Gastmans, C., Mahieu, L., Dierckx de Casterlé, B., & Denier, Y. (2017). How do ethnic minority patients experience the intercultural care encounter in hospitals? A systematic review of qualitative research. BMC Medical Ethics, 18(1), 1-17. Web.
Levin-Zamir, D., Leung, A. Y. M., Dodson, S., & Rowlands, G. (2017). Health literacy in selected populations: Individuals, families, and communities from the international and cultural perspective. Information Services & Use, 37(2), 131-151. Web.
Neiman, P. U., Tsai, T. C., Bergmark, R. W., Ibrahim, A., Nathan, H., & Scott, J. W. (2021). The Affordable Care Act at 10 years: Evaluating the evidence and navigating an uncertain future. Journal of Surgical Research, 263, 102-109. Web.
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