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5.1 Demographic Factors

The demographic makeup of the U.S. population continues to change, with communities that have concentrations of groups such as older people, minority racial and ethnic groups, and others often underrepresented in the social and political power structure. Such groups tend to experience higher rates and greater severity of chronic disease, lack of access to and a distrust of health care resources, and the inability to afford health insurance. The fastest-growing demographics are baby boomers, racial and ethnic minorities, and vulnerable groups like those living in poverty, sexual and gender minorities, and individuals with disabilities. As these demographic changes continue, the delivery of health care will have to change to ensure health equity and the elimination of health disparities, which currently impact underrepresented populations disproportionately throughout the United States.

5.2 Health Care Consumer Behavior

Factors that affect health care consumer behavior include cost, availability of services and providers, and degrees of consumer confidence in those services and providers. Consumer behavior affects health care costs. For example, populations that tend to neglect health care until chronic diseases and mental health disorders become severe are more costly to treat than preventive care would have been. This also pushes up the price of costly prescriptions needed to treat advanced health conditions. Conversely, the high cost of health care and health care insurance prevents consumers from using health care services. Many consumers turn to emergency department visits because hospitals by law cannot turn away clients. If the client is unable to pay, the hospital bears the cost of care given, thereby further increasing the cost of health care overall. As the face of America continues to change, how individuals as consumers interact with the health care system will increasingly be a factor that must be addressed.

5.3 Virtual Care and Technology

As U.S. demographics change, developing new ways to reach and care for clients is crucial to ensure positive health outcomes. Technologies such as telehealth vastly increase the accessibility of health care providers and services. Telehealth has proven especially effective in improving accessibility to rural areas that often have fewer health care facilities and providers. Additionally, as care of older adults shifts from hospitals and rehab centers to the home, home monitoring, EHRs, and telehealth can enable high-quality, safe, and comfortable homecare for clients. The same is true for the monitoring of chronic diseases such as diabetes, which especially affects minorities and older adults.

5.4 Health Care Workforce

Nurses are the backbone and necessary component of the health care system, which cannot function without them. The current severe shortage of nurses is caused partly by the aging of the nursing workforce (the number of nurses reaching age 65 and retiring) and partly by the COVID-19 pandemic. The significance of the nursing shortage is prompting a great deal of attention on estimating the number of nurses needed for the health care system to function properly and on how to train and recruit new nurses. At the same time, the need for greater diversity in the nursing workforce is gaining increased recognition and attention.


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