Barriers to healthcare

For this Module assignment, create an outline that depicts the challenges and barriers to healthcare access in your setting. Then, create a table that reflects the continuum of care process for a patient population in your healthcare setting.

The patient population is Veterans.

The setting is a Medical Facility that offers out-patient treatment for various physical/mental health. We have clinics for primary care, mental health, PTSD, and specialty clinics.

The obvious challenges are locations and transportation.

A less obvious challenge is mental health disease.

The barrier to care can be financial and homelessness.

Veterans to receive care at a VA Center must be active duty, retired, below the poverty level, or have a service connection.

To become service-connected, you must file a claim for disability. You will go through a review board to determine if this issue was directly caused by your military service. If approved, they will determine how severe the disability is an award it a percentage.

If they are service-connected, they will only receive care for the issue that is service-connected unless they are 100%

The issue with this is that you will see a VA provider for the service-connected issue and an outside provider for your remaining health care needs.

This can cause a delay in care or missed issues due to different electronic health care systems that are not compatible.

The VA has a national system. Therefore there is continuity of care.

Veterans who do not meet those criteria are not eligible for care through the VA.

Not being able to navigate the system is an issue for many veterans. One workaround is get admitted to our acute psychiatric unit. While they are inpatient, they then address their health needs to our treatment team.

Many veterans refuse to go to outside providers because they feel that they just don’t understand what they are going through having not served themselves.

Continuum of care

Allow every veteran in the surrounding areas to each facility to register with them. Assess their eligibility for care. Then based on that category assign a case manager to them. The case manager’s number of veterans to follow will be based on their level of eligibility. If they are 100% service-connected, active duty, or retired, they have full access to care. The case manager would have fewer of these veterans. If they are less than 100% but greater than 50%, they would be in one assignment with a more significant number than 100%. If they are less than 50% service-connected, this would be the most extensive assignment for the case manager. Case managers are critical at ensuring care is not missed at transition points.

Transition points could be home to hospital, hospital to rehab and back to home.

Because a large portion of our population is dealing with mental health disease, depression, PTSD, Suicidal ideation, substance abuse, or age-related decompensation a patient navigator would be a great asset.

Home health care is valuable service. Keeping veterans out of the hospital and in their homes can an affordable option to hospitalization. Home health has a range of services from aides, LPN’s, RN’s, OT and PT. The amount of services needed and the length of the service would be dictated by the patients needs.

Out patient clinics such as disease management programs and wellness centers are a valuable and cost effect service. These clinics not only offer medical care, but valuable teaching.

Telemedicine is a cost effective, time saving option. There is a learning curve for many of the veterans. This could be solved by sending out a representative. They way that cable companies will come out and set up your cable or internet service, so too could the healthcare agency.

Cheney, Koenig, Miller et al found there to be five barriers to care, one of which is the ability to navigate the system.

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Solution

Challenges to Healthcare Access among Veterans

Some of the challenges to healthcare access among veterans include;

• Concerns about stigma.
• The frustrations that arise because of the inconvenience and the cost of healthcare.
• The competing life priorities some of them that include finding work, housing, and providing for their families while at the same time trying to succeed academically (Misra-Hebert et al., 2021).
• Most veterans suffer from more than one health condition making it hard for them to undergo treatment.
• Both men and women have experienced sexual trauma including assault and harassment while in the military (Misra-Hebert et al., 2021).

Barriers to Healthcare Access among Veterans

Veterans face myriad barriers in their bid to access healthcare services. Some of the barriers that prevent veterans’ healthcare access include the following.

• There are concerns about what other people think especially if this involves mental health (Cheney et al., 2018).
• There are concerns about the veteran’s capability to pay for the healthcare services.
• There is lack of confidence in in the VA healthcare system and its ability to treat the disease affecting the diseases (Cheney et al., 2018).
• The veterans find it hard to navigate VA benefits and healthcare services.
• The veterans are socially isolated by other people making it hard for them to access the requisite health care services (Cheney et al., 2018).
• Some veterans are far from the specialized services that can handle their healthcare needs.
• In some cases, there is unavailability of specified services that include early intervention services (Cheney et al., 2018).
• Some veterans experience homelessness and coupled with their healthcare needs this makes it hard to prioritize their needs.
• The veterans that obtain care must be in active duty, retired, or below poverty level, or have service connection.

Continuum of Care Process

In the continuum of care process, it highlights some of the complexities that arise in providing care for the veteran population. The care process commences with the veteran being allowed to register for any form of service be it a hospital, rehab, or mental hospital. After registering for service, then the veteran must be assessed for eligibility. The eligibility determines if the veteran will proceed to the next phase of care where they are assigned a case manager. A medical case manager recommends the treatment plans that are available for the veteran depending with various conditions. Certainly, if the veteran is 100% service connected, active duty, or retired then they have full access to care. Since there are few veterans that satisfy these preconditions, the case manager at any given time has fewer veterans. If they are less than 100% but greater than 50% the veterans they would be in on assignment but with a more significant number as compared to 100%. The last precondition is if they are less than 50% this would mean more of the veterans as such more assignments for the case manager. As a result, the case manager would have a lot of work to do facilitating treatment plans for the veterans. The table below highlights the continuum of care process for the veterans.

Cheney, A. M., Koenig, C. J., Miller, C. J., Zamora, K., Wright, P., Stanley, R., Fortney, J., Burgess, J. F., & Pyne, J. M. (2018). Veteran-centered barriers to VA mental healthcare services use. BMC health services research, 18(1), 591. https://doi.org/10.1186/s12913-018-3346-9