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Disparities in Healthcare

Introduction
Today, the persisting inequality in the national health care system is one of the major challenges to the US policy-makers and one of the major threats to the national security. In fact, today, gaps between different social classes and racial/ethnic groups in terms of access to health care services grow wider. This means that representatives of the upper-class have better access to health care services of the higher quality compared to representatives of the low- and middle-class, whereas representatives of the white majority have also better and wider access to health care services compared to Hispanics, Native Americans, and other minorities. In such a situation, the elimination of barriers on the way of all Americans to health care services and creating equal opportunities for all to access health care services of the high quality is one of the major challenges and one of the strategic goals of the US policy-makers and health care professionals. The public grows more and more concerned with the elimination of inequality in health care services, while the current health care reform should eliminate this inequality. In fact, the elimination of the persistent inequality in the US health care system is essential to make finally health care services a public good but not a mere commodity available to the representatives of the upper-class solely.

 

1. The difference between core concepts related to inequality in the health care system
In actuality, the national health care system suffers from substantial differences in the provision of health care services to the population. In this regard, it is necessary to define core concepts related to the persisting differences in the provision of health care services to the population of the US. The core concepts, which mirror the difference in the provision of health care services to the US population, are disparities, inequity and inequality.

A. Disparities
Disparities in the health care system imply the difference in the provision of health care services to different groups of patients, depending on their race, social status or other differences. In actuality, disparities in the national health care system reveal the difference in the access and the quality of health care services delivered to patients in the US.

B. Inequity
Inequity in health care means the unfair or unjust attitude to certain patients, for instance, minorities. In fact, inequity implies that existing differences are unfair and unjust
C. Inequality
Inequality in health care means the difference in the position of individuals and their access to health care system or health care services. Inequalities emerge, when people have different opportunities. In this regard, people are in unequal position in terms of health care services because they have different opportunities to have access to health care services, they have different health care plans and they suffer from other inequalities because of their different socioeconomic position, social standing or race/ethnicity.

2. Existing status of disparities
A. Disparities
Today, the US health care system suffers from numerous disparities, which raise many barriers on the way of some Americans to health care services of the high quality. In this respect, it is worth mentioning the fact that the most obvious disparity exists in the field of health care insurance. In actuality, many Americans suffer from the lack of insurance, which is one of the major disparities in the US national health care system. In fact, the lack of insurance coverage is a serious obstacle to health care services being delivered to all Americans. The lack of insurance coverage puts uninsured Americans into a disadvantageous position because they cannot count for health care services insured Americans have access to. Today, the share of uninsured Americans is close to 25% (Goldberg, Hayes, and Huntley, 2004).

At the same time, the lack of insurance coverage for health care services lead to the development of another problem, the lack of a regular source of care. In fact, uninsured Americans do not have a regular source of care. Moreover, insured Americans may also face a problem of the lack of regular source of care because they cannot always afford paying for their health care services. As a result, they cannot have access to health care services on the permanent basis (Weinick, Zuvekas, & Cohen, 2000). In fact, health care services become unavailable to Americans, if they cannot afford health insurance or pay for their health care services.
Furthermore, the contemporary health care system suffers from the lack of financial resources, which provokes disparities in the access of Americans to health care services as well as the ability of Americans to pay for their health care services. In such a way, the lack of financial resources provokes the growing disparity in the national health care system and among Americans.

In addition, many Americans suffer from the scarcity of care provides. In this regard, it is worth mentioning the fact that the number of clinics and hospitals as well as the number of health care professionals in inner cities is lower compared to other regions, where representatives of the upper- and middle-class live. In such a way, health care services need consistent changes to close gaps and to provide health care services for all Americans on the equal basis.

Finally, it is important to place emphasis on the fact that the disparities in health care services are particularly obvious, when the access of Americans to health care services is analyzed in terms of race or ethnic origin. What is meant here is the fact that representatives of different racial and ethnic groups suffer from disparity in access to health care services. In this regard, the white population of the US is in a disadvantageous position compared to other Americans (See App. Table 1). The statistical data prove that white Americans have wider access to health care services compared to minorities (See App. Table 1).

B. Caucasians vs. Native Americans
In actuality, Native Americans are in a disadvantageous position compared to Caucasians (See App. Table 1). IN this regard, it is worth mentioning the fact that Native Americans suffered from the lack of health care services historically. In addition, many Native Americans prefer using traditional, Native American methods of treatment, instead of the contemporary medical services. In such a situation, Native Americans have low confidence in the contemporary health care system and they prefer using their traditional methods of treatment, which they inherited from their ancestors.
In addition, many Native Americans suffer from the lack of financial resources to afford health insurance. In other words, Native Americans cannot afford health insurance and, therefore, they cannot access health care services on the equal ground compared to Caucasians. As a result, the disadvantageous position of Native Americans prevents them from the access to effective health care services.

C. Caucasians vs. Hispanics
Similar trends can be traced in relation to Hispanic population of the US. To put it more precisely, a considerable part of Hispanic population lives in poverty. As a result, they suffer from the lack of financial resources and they cannot afford health insurance. At this point, it is worth mentioning the fact that the share of Caucasian population having health insurance is larger compared to the share of Hispanic population having health insurance. Hence, a number of insured Hispanics is lower compared to the number of Caucasians and, what is more, the proportion of insured Hispanic is lower compared to the share of insured Caucasians (See App. Table 1).

As a result Hispanic population turns out to be in a disadvantageous position compared to white Americans. At the same time, a considerable part of Hispanic population is represented by illegal immigrants, who suffer not only from the lack of financial resources to pay for health insurance but they have problems with their legal status, which prevents them from obtaining equal access to health care services compared to Caucasians.

D. Reasons for disparities
In such a context, it is important to understand reasons of such disparities in the position of Caucasian population and minorities. In actuality, the major reason of disparities in access to health care services is the lack of financial resources and the low level of income in minority communities (Brodie, 2000). To put it more precisely, the lack of financial resources and the low level of income make health insurance unaffordable for representatives of minorities and for representatives of the lower-class.

At the same time, the lack of legal regulations prevents illegal immigrants, which are predominantly Hispanics, from the equal access to health care services. In such a way, illegal immigrants are in a disadvantageous position compared to American citizens because they have the low income and they have no legal status, which could allow them to receive health care services or count on any health care plan.

E. How can these be reduced or possibly even eliminated?
In actuality, the health care reform can change the situation in the national health care system for better. In this regard, health care reform should focus on the provision of all citizens with equal access to health care services. To put it more precisely, the government should regulate legally the status of illegal immigrants as well as other citizens to provide them with the possibility to have access to health care services. In addition, the government should develop government-support program to provide uninsured Americans with the access to health care services.

F. Solutions
In such a context, the legal changes are essential for the solution of current problems in the health care system. At the same time, the government support may include the development of programs similar to Medicaid and Medicare as well as with the state funding of certain health care organizations or health care programs.

3. Challenges
However, the government faces considerable financial problems because today the US suffers from the economic recession and its negative effects. In addition, the government support and funding of health care services raises the problem of the introduction of new taxes and finding financial resources to cover new health care programs and government support of health care services.

4. Benefits
The health care reform aiming at the elimination of disparities in the legal status of citizens to provide them with equal access to health care services will allow many people living and working in the US to get access to, at least, elementary health care services. Government programs aiming at support of health care services can enroll all Americans in the national health care system and to provide them with health care services.

Conclusion
Thus, the national health care system suffers from numerous disparities. A considerable part of Americans suffer from the lack of access to health care services. In such a situation, the health care reform should change the situation for better. In this regard, the government should change the existing legislation to provide all people living and working in the US with equal opportunities to get access to health care services. In addition, the government should develop health care programs and offer uninsured Americans health care plans, which can provide them with equal opportunities to have access to health care services compared to insured Americans.

References:
Brach, C. & Fraser, I. (2000). Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model. Medical Care Research and Review, 57, 181-217.
Brodie, M. et al. (2000). Health information, the Internet, and the digital divide. Health Affairs; 19(6):255-65.
Collins, K. et al. (March 2002). “Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans,” Commonwealth Fund.
Fiscella, K., et al. (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. JAMA: The Journal of the American Medical Association, 283(19), 2579-2584.
Goldberg, J., Hayes, W., and Huntley, J. (November 2004). “Understanding Health Disparities.” Health Policy Institute of Ohio.
Henry J. (October 1999). “A Synthesis of the Literature: Racial and Ethnic Differences in Access to Medical Care. Kaiser Family Foundation (KFF).
Isaacs, J.D., Stephen L. and Steven A. Schroeder. (Sep 2004). “Class – The Ignored Determinant of the Nation’s Health”. New England Journal of Medicine 351.11, 1137-1142.
McDonough, J. B. et al. (June 2004). “State Policy Agenda to Eliminate Racial and Ethnic Health Disparities,” Commonwealth Fund.
Merzel, C. (2000). Gender differences in health care access indicators in an urban, low-income community. American Journal of Public Health, 90(6), 909-916.
Weinick, R. M., Zuvekas, S. H., & Cohen, J. W. (2000). Racial and ethnic differences in access to and use of health care services, 1977 to 1996. Medical care research and review : MCRR, 57 Suppl 1, 36-54.
US Census Bureau. 2011. Retrieved on October 12, 2011 from http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/race.xls

Appendices:

Table 1.
People Without Health Insurance Coverage by Race and Hispanic Origin Using 2- and 3-Year Averages: 2007-2008, 2009-2010, and 2008-2010

(Numbers in thousands. People as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see www.census.gov/apsd/techdoc/cps/cpsmar11.pdf)

3-year average 2008-2010 2-year average Change (2009-2010 average less 2007-2008 average)2

2007-2008 2009-2010

Race1 and Hispanic origin 90-percent 90-percent 90-percent 90-percent
confidence confidence confidence confidence
Estimate interval3 (±) Estimate interval3 (±) Estimate interval3 (±) Estimate interval3 (±)

NUMBER UNINSURED

All races……………………………………………………………… 47 890 499 44 434 511 49 444 594 *5,010 695

White ………………………..…………..…………………………………………………. 36 092 448 33 495 479 37 254 508 *3,759 582
White, not Hispanic…………………………………………………………….. 22 132 329 20 157 387 22 904 393 *2,747 507

Black………………………………………………………………..………………………. 7 663 171 7 019 196 7 985 208 *965 277

American Indian and Alaska Native…………………………..………. 757 92 848 104 727 98 -121 89

Asian ……………………………………………………………………………..………… 2 383 116 2 182 123 2 459 137 *276 172

Native Hawaiian and Other Pacific Islander…………………..…. 158 27 133 28 169 35 37 43

Hispanic (any race)………………………………………………………………… 14 982 278 14 326 262 15 395 309 *1,069 314

PERCENTAGE UNINSURED

All races……………………………………………………..……… 15,8 0,2 14,8 0,2 16,2 0,2 *1.4 0,2

White ……………………………………………………………………………………….. 14,9 0,2 13,9 0,2 15,3 0,2 *1.4 0,2
White, not Hispanic…………………………………………………..………… 11,2 0,2 10,2 0,2 11,6 0,2 *1.4 0,3

Black………………………………………………………………………………..………. 19,9 0,4 18,5 0,5 20,6 0,5 *2.1 0,7

American Indian and Alaska Native……………………………………. 28,1 2,2 30,3 2,8 27,8 2,4 -2,6 3,0

Asian ……………………………………………………………………………..………… 17,2 0,8 16,4 0,9 17,3 0,9 0,9 1,2

Native Hawaiian and Other Pacific Islander……………..………. 18,4 2,5 16,7 3,2 19,9 3,3 3,3 4,5

Hispanic (any race)……………………………………………………………….. 30,7 0,6 30,7 0,6 31,1 0,6 0,5 0,7

* Statistically different from zero at the 90-percent confidence level.
1Federal surveys now give respondents the option of reporting more than one race. Therefore, two basic ways of defining a race group are possible. A group such as Asian may be defined as those who reported Asian and no other race (the race-alone or single-race concept) or as those who reported Asian regardless of whether they also reported another race (the race-alone-or-in-combination concept). This table shows data using the first approach (race alone). The use of the single-race population does not imply that it is the preferred method of presenting or analyzing data. The Census Bureau uses a variety of approaches. Information on people who reported more than one race, such as White and American Indian and Alaska Native or Asian and Black or African American, is available from Census 2000 through American FactFinder. About 2.9 percent of people reported more than one race in the 2010 Census.
2Details may not sum to totals because of rounding.
3A 90-percent confidence interval is a measure of an estimate’s variability. The larger the confidence interval in relation to the size of the estimate, the less reliable the estimate. Confidence intervals shown in this table are based on standard errors calculated using replicate weights instead of the generalized variance function used in the past. For more information see “Standard errors and their use” at <www.census.gov/hhes/www/p60_239sa.pdf>.

Source: U.S. Census Bureau, Current Population Survey, 2008 to 2011 Annual Social and Economic Supplements.

Source: US Census Bureau. 2011. Retrieved on October 12, 2011 from http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/race.xls