Introduction

Healthcare accessibility in rural areas and low-income communities requires more than distance travel since patients need to establish trust and must overcome time limitations by making numerous improvising decisions. A mother asks friends to let her use their vehicle temporarily. A young man has to miss his meals to accumulate enough money for a visit to the clinic. The elderly patient counts his prescription pills to make them last longer since he does not know when he will be able to get his next appointment. Insurance status determines everything about the patient experience in these communities because it complicates medical care access and transforms every interaction with healthcare providers. A person’s experience with healthcare depends on whether their symptoms get recorded, and their complaints get validated as well as their reported pain receiving valid consideration.

I’ll investigate how citizens experience being uninsured by by means of oral testimonies and evidence from recent studies. Focusing on the mental and social effects of using uninsured status to face healthcare services which produce stress and social stigma along with low trust in institutions and the differences in healthcare quality through shorter appointments and limited diagnostic tests and delayed treatment for uninsured patients. The nation’s fragmented healthcare system becomes visible through patient and provider accounts which illustrate its concealed expenses.

Psychological and Social Impacts

The psychological weight of lacking medical insurance remains out of sight yet produces intense feelings within individuals. People with low income must endure both their sickness and the combination of feelings that come from lacking medical care access. The healthcare worker and North Carolina mother Susan Villnave shares through her oral history how healthcare inequalities merge with socioeconomic factors and public perception and psychological well-being in her community. Healthcare remains inaccessible to many people because their income level prevents them from qualifying for assistance although they cannot afford medical services [08:03–08:09] ¹. The research data supports the observed experiences. Hoffman and Paradise establish that people without insurance tend to delay medical treatment and face challenges with follow-up care while staying away from medical services because they worry about costs and distrust healthcare providers. The emotional weight of healthcare struggles increases according to Hawthorne and Kwan because lower-income communities experience both economic and geographical barriers to healthcare access. Transportation gaps function as overlooked barriers to healthcare access in addition to economic and spatial fragmentation. The fear and lack of full access to medical care forces patients to endure even routine health concerns which become both emotionally taxing and mentally draining. Through her personal account Villnave demonstrates how prejudice impacts the current situation. The ER doctor displayed skepticism toward his symptoms until he noticed elevated cardiac enzymes in the test results. According to Villnave the doctor displayed a negative attitude until he received the test results which led to an immediate change in his behavior [14:13–17:00] ¹. The healthcare system perpetuates an unfair prejudice that uninsured patients along with those who receive little income tend to fabricate their medical needs and seek medication needlessly. Patients develop both mistrust toward their healthcare providers and self-worth issues because they absorb the message that their medical needs do not deserve professional attention.

Differences in Quality of Care

The effects of being uninsured go further than psychological damage. These healthcare consequences become visible through the practice of medical service provision. Dr. George Gould who works at a rural community clinic has personal experience with these healthcare differences since patients with insurance receive better medical services. People who lack insurance coverage rarely encounter the top medical specialists and their healthcare receives delayed or entirely missing treatment [26:53] ². The study conducted by Baker et al. reveals that symptomatic patients without insurance receive diagnostic services at lower rates and receive fewer specialist referrals and experience inferior medical results. ⁴ The health disparities that exist are fatal in nature rather than just causing minor difficulties. The time span between proper medical tests and delayed treatment determines if a condition becomes treatable or transforms into a critical health emergency. People without insurance must face restricted healthcare services even when they succeed in accessing medical facilities. Gould explains that healthcare operations are now controlled by insurance companies more than by medical professionals because insurance policies determine what to cover [25:01–26:40] ². The clinics operate as essential components of his healthcare approach while he admits their current state of overload combined with insufficient resources because “There’s still too many people out there.” The limited financial capabilities of patients force healthcare providers to give them brief medical consultations together with minimal diagnostic testing while delivering advice based on their budget constraints rather than their genuine healthcare requirements.

When Status Meets Stigma

The difficulties for migrants and undocumented persons exceed those faced by other populations. According to Gould the majority of his patients speak Spanish as their preferred language thus illustrating the essential need for interpreters. The barriers created by language form only a fraction of the entire challenge. Patients who lack health insurance because of immigration status face barriers to both public and private health insurance options. Routine healthcare exists as an infrequent privilege while becoming an occasional calculated risk because of legal exclusion. These patients decide to skip medical care because they fear the process or believe it is useless. According to Gould migrant men who are uninsured and employed choose not to visit doctors regardless of their health status [27:44] ². People who work and reside in American communities exist outside the healthcare system’s protections because they lack protection from the system. The authors Hawthorne and Kwan identify these realities as part of an extensive structural geography of exclusion which produces “unequal landscapes” where medical care is both far away and costly and emotionally distant. The resulting landscapes emerge from deliberate policy decisions which perpetually ignore the needs of low-income individuals and migrant communities. Insurance operates as an entry controller that prevents patients from receiving quality care while causing patients to lose their trust in the healthcare system. Insurance serves as more than financial barriers because it operates as a barrier that controls the quality-of-care patients receive and their sense of dignity. The insurance system creates deep structural inequalities as doctors George Gould and Susan Villnave describe how patients receive dismissal or delayed care, and providers must manage through defective healthcare frameworks.

Conclusion

These personal testimonies demonstrate what statistical data cannot show because they expose the mental burden of patients and unspoken biases and persistent moral burnout. The research by Hoffman and Paradise demonstrates that uninsured patients avoid medical treatment entirely when they lack health insurance coverage and Baker et al. prove that medical care received by uninsured patients typically results in inferior health results. ⁴ The healthcare system of America will persistently fail its most vulnerable population until it provides both unrestricted entry and genuine equality and genuine respect.

Footnotes:

1) Villnave, Susan. Interview with Madelaine Katz. 23 July 2019 (Y-0134). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

2) Gould, George. Interview with Joanna Ramirez. 26 June 2018 (Y-0026). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

3) Hawthorne, Timothy, and Mei-Po Kwan. “Exploring the Unequal Landscapes of Healthcare Accessibility in Lower-Income Urban Neighborhoods through Qualitative Inquiry.” Geoforum, 2013. www.sciencedirect.com/science/article/pii/S0016718513001711.

4) Baker, David, et al. “Health Insurance and Access to Care for Symptomatic Conditions.” JAMA Network, 2000. jamanetwork.com/journals/jamainternalmedicine/fullarticle/485304. 

5) Hoffman, Catherine, and Julia Paradise. “Health Insurance and Access to Health Care in the United States.” The New York Academy of Sciences, 2008. nyaspubs-onlinelibrary-wiley-com.libproxy.lib.unc.edu/doi/10.1196/annals.1425.007.