Protecting and Serving Vulnerable Health Care Populations

While much is said about the monetary cost of fraud in health care, the danger to patients is more than just financial. Between 2012 and 2015, 1.2 million Medicare beneficiaries were defrauded by health care providers, and many were from vulnerable populations.

In 1966, more than three-fourths of Americans had great confidence in medical leaders; but today, only 34% do. The gaps of trustworthiness are even larger for vulnerable populations.

What are the most vulnerable populations in health care and how can practitioners meet their needs? What makes a patient vulnerable and what steps can providers take to ensure their communities continue to trust their practitioners? These are some of the most important issues facing the health care profession today and are critical to ensuring these underserved populations receive the care they need.

5 Vulnerable Populations in Health Care

1. The Chronically Ill and Disabled

Legally, a chronically ill patient is one who is unable to perform (without substantial assistance from another individual) at least two activities of daily living for a period of at least 90 days due to a loss of functional capacity.

However, the legal definition isn’t the only one that matters, and many people with chronic illnesses are able to carry out their daily tasks and manage their symptoms. A chronic illness is typically long-lasting and incurable. They’ll often see many specialists, and can be at high risk for depression and other mental disorders.

The ADA defines a disabled person as one who “has a physical or mental impairment that substantially limits one or more major life activity.” However, the legal definition isn’t a medical term and disability can cover a wide spectrum of disorders and functionality.

2. Low-income and/or Homeless Individuals

The federal poverty level for individuals begins at $12,760. Many government programs use the federal poverty level to determine benefits. However, the federal poverty level isn’t the only indicator of low-income individuals. Many people who are on SSI, Social Security Disability, or who are retired and receiving Social Security income are also low-income.

Homelessness and poverty often go hand-in-hand. Low-income individuals often find it difficult to find affordable housing, health care, or reliable transportation and can struggle to find and keep a job.

According to the National Coalition for the Homeless, “Poor health is both a cause and a result of homelessness.” Health care services for low-income and homeless people have several critical barriers including lack of knowledge, poor access to transportation, lack of identification, and shame or embarrassment.

3. Members of Certain Geographical Communities

When it comes to lack of access to health care services, rural communities often come to mind. Nearly 80 percent of the rural United States is designated as medically underserved. And this problem will continue to grow as aging doctors retire from their practices. The number of doctors in these areas is expected to decline by 23 percent over the next decade.

It’s not just doctor visits that can be hard to come by in rural areas; specialists, hospitals, and surgeons can be a hundred miles away or more. While telehealth has helped to bring specialists, coordinated care, and other services to these areas, there is still a continued crisis.

4. LGBTQ+ Population

For LGBTQ individuals, finding a trusted, safe health care provider can be a significant struggle. According to a recent poll, nearly one-sixth of LGBTQ adults have experienced discrimination and one-third of transgender patients had at least one negative experience related to being transgender.

This is especially relevant since LGBTQ people are at dramatically increased risk of developing mental health disorders and attempting suicide, especially if they aren’t surrounded by a supportive community.

5. The Very Young and Very Old

The elderly and the youngest in our population rely heavily on caregivers to ensure they’re receiving proper care. And since babies and elderly patients can also fit into other vulnerable categories, their access to health care is at an increased risk.

Family income and lack of access to proper nutrition can have serious consequences for children and their development. Low-income children can also be at higher risk for abuse and exploitation. For elderly patients, lack of access to a dedicated caregiver or the inability to perform basic daily tasks puts them at increased risk for abuse and neglect as well.

What Makes a Patient Vulnerable?

Vulnerable patient populations are complex and not easily defined. A vulnerable patient can be a person who is poor, may not speak the primary language of the community in which they live, have a limited educational background, or could live far from the nearest hospital or clinic.

Vulnerable populations are often at heightened risk for contracting illnesses or disabilities and face significant barriers to receiving quality care. They are less likely to receive preventative care such as vaccinations and regular check-ups, and often end up in the emergency room instead of with a qualified primary care physician.

Protecting Vulnerable Patient Populations from Fraudulent Health Care Providers

One of the significant dangers for vulnerable patients is receiving care that is either insufficient or even dangerous at the hands of an unqualified or fraudulent provider. In a recent study, Laura Nicholas, an assistant professor in the Department of Health Policy and Management at The Johns Hopkins Bloomberg School of Public Health, found that fraud and abuse perpetrators are treating vulnerable populations at increasingly higher rates than other providers. One of the many reasons this is happening is due to the lack of available resources for vulnerable populations to identify and report abusive caregivers or providers.

With more and more fraudulent provider reports on the rise, it is important for organizations to ensure transparency when hiring providers or contracting with entities to provide safe practices for patients. Verisys plays an important role in protecting vulnerable populations by ensuring that practitioners and providers are properly screened, verified, and monitored regularly, raising red flags when checking abuse and sex offender registries, exclusion lists and thousands of other primary sources. Verisys supplies the most accurate data to ensure organizations are protecting their most vulnerable patient populations. Organizations using Verisys for these services help protect patient populations while eliminating risk to their organization.

Written by Heather Lynn Gillman Director of Healthcare Communications Problem Solver. Designer. Wine Maker. Writer. Connect with Heather on LinkedIn