Racial disparities in United States health care access and quality

Health Care Disparities Race Related

Healthcare disparities

Serial number

Socioeconomic status and health

Correlation between socioeconomic status and race

Health insurance and health

Who are the uninsured people?

Causes of health care disparities

Suggestions for better health care system

The latest studies have shown that in spite of the steady developments in the overall health of the United States, racial and ethnic minorities still experience an inferior quality of health services and are less likely to receive routine medical testing which contributes to disease and even death. This research paper will seek to answer the question as to why there is race related disparity in health care and what we can do to improve the health care for those affected due to their race.

Health Care Disparities Race Related

Research Methodology:

A comprehensive survey was conducted in both public and private sector of the United States health care system in order to examine the public opinion about the racial disparities in the system. In addition to that some secondary data including books, websites, journals etcetera was also used.

Introduction and Background:

The United States health care system has been subjected to immense debate. There are people who argue that United States of America has got the best health care system in the world. They support their argument by pointing to the free availability of medical care and availability of advanced technology and facilities. While there are other people who say that the United States health care system is quite inefficient as compared to the massive expenditures that the government makes on it. They argue that despite this massive expenditure the United States health care system suffers from inefficiency and dissatisfactory quality.

Both the private and the public insurers are present in the United States health care system. But what makes the U.S. health care system different from the health care systems of other countries of the world is the influence of private sector over the public sector. In the year 2003, private employer sponsored medical insurance was given to the 62% of the non-elderly U.S. citizens whereas; the private non-grouped or individual medical insurance was purchased by 5% of non-elderly citizens. Public sector medical insurance was provided to 15% of the non-elderly citizens however 18% of the citizens were not insured. Elderly citizens of age 65 and over are periodically insured by public insurers such as Medicaid. (Chua, 2006)

The public sector includes the following programs:

Medicare: It is a federal program. Individuals who age 65 and over are covered by it. Medicare also covers certain individuals who are disabled.

Medicaid: This program is directed towards disabled and low income citizens. According to the law of the State insurance should be provided to low income pregnant women, disabled citizens and elderly people. Medicaid does not cover adults with no children.

The State Children's Health Insurance Program: this program was enforced in 1997 to cover the children whose family does not qualify for Medicaid but due to low income they cannot afford private insurers.

Veteran's Administration: It covers the military officials. It is financed by government's tax income and provides quite affordable services to the veterans of the military. These services are provided in military hospitals and clinics. (Chua, 2006)

The private sector of the United States health care system consists of the following programs:

Employer-sponsored insurance: It is the most basic kind of insurance where the employers provide health care facilities to the employees as a part of their benefits or salary plan.

Private non-group or individual insurance: This program covers the individuals who are indulged in their own business, retired citizens and the officials or employees who are not insured by their organizations or employers. (Chua, 2006)

The public sector of the United States health care system is mostly financed by the tax earnings of the government. In private sector, for employer based insurance employers pay most of the premiums and the remainder is then funded by the employees and in individual insurance all of the premiums are paid by the individual who is being covered by the insurance.

The Population of United States of America:

About one third of the population of America is constituted by minorities. The graph below shows the contribution of different racial and ethnic groups in the population of United States of America. (Mead, Cartwright-Smith, Jones, Ramos & Siegel, 2008)

(Mead, Cartwright-Smith, Jones, Ramos & Siegel, 2008)

Whites contribute 67% in the total population. Blacks and Asians contribute 12% and 4.2% respectively. The minimum contribution is made by American Indians which is 0.8%. Hispanics contribute the highest among the minorities which is 14%.

It is also projected that minorities will form about half of the population of the United States of America till 2050. The graph below shows the projected population of United States of America. (Mead, Cartwright-Smith, Jones, Ramos & Siegel, 2008)

(Mead, Cartwright-Smith, Jones, Ramos & Siegel, 2008)

The graph shows a decline in white population from 69% to 50%, Hispanic population will increase from 13% to 24%, black from 13% to 15%, Asian from 3.8% to 8% and the contribution of other minorities will increase from 2.5% to 5.3%.

Racial Disparities in Health care System:

Racial inequalities in the health care system are related to the biased beliefs and behaviors of the society. Racial discrepancies are not a result of individual behavior instead they are deeply rooted in the policies, procedures and rules of the health care institutions. Such disparities are also a result of the basic values and beliefs that are instilled in the society since childhood. (Williams & Rucker)

Who are the uninsured people?

Economic Status: Usually people who belong to low economic status or working class are the ones who are uninsured. The major reasons behind people not getting insurance are non-availability of insurance at the place of work and high costs of insurance programs. A study revealed that out of every 10 uninsured people at least 8 belonged to the low socioeconomic class. About 70% of the uninsured people belonged to low status fulltime working class, 12% belonged to those who had one member of the family working part time and only 19% belonged to the class who had no connection with the working class. People with low income are less likely to have insurance as they have no access to employer sponsored insurance and they cannot afford individual or non-group insurance. (Devi, 2005)

Level of Poverty: It has also been observed that poor people are more likely to be uninsured than the rich ones as only 17% of this group has employer sponsored insurance. 41% of the people are covered by the Medicaid program and remaining 33% of the people belonging to this group remain uninsured. As far as the nearly poor people are concerned they are not covered by Medicaid as they do not qualify for it hence 28% of the people belonging to this group remain uninsured. (Devi, 2005)

Racial Groups: Above 50% of the uninsured people belong to the racial minorities. This is because about 50 to 60% of the families, belonging to racial and ethnic minorities, live below poverty level. But researches indicate that economic status is not accountable for the discrepancies in insurance coverage because such racial discrepancies exist at both high and low level. (Devi, 2005)

Causes of Racial Disparities in Health Care System:

Disparities in health care are not a new thing. Communities have suffered inequalities just because of their color for a long time. The field of lack of access to health care for communities has never got governmental attention. Despite of the endeavors used by people to suppress racism, communities still face inequalities in many services. According to the National Healthcare Disparities Report (NHDR), the access to health care facilities for African-Americans and American Indians is almost the same but it is drastically low for the Latinos. Latinos receive same access as the whites in only 17% of the areas and in the rest of the 83% areas, the Latinos receive nothing but inequalities. These statistics have shown an improvement over time for African-Americans and American Indians but they deteriorated for the Latinos. ("Unequal health," 2008)

Quality of health care also matters especially if the diseases are serious. Even in this area, the inequalities are exceeding par. The African-Americans and the Latinos get 73% and 77% poorer health care quality as compared to whites respectively, whereas the Asian-Americans and American Indians fared 32% and 41% as compared to the whites. The figures kept worsening over time. From 1999 to 2004 the adults who were not receiving a pneumonia vaccine fell for the whites (from 48% to 41%) but it went from 59% to 65% for the Asians. ("Unequal health," 2008)

Biased insurance coverage:

One reason for these disparities is that the minorities receive less medical insurance than the whites. The white Americans receive medical insurance whereas the communities of color lack proper medical insurance. According to a research, roughly 21% white Americans were deprived of medical insurance in2002. However, the colored Americans were considerably worse with 28% of African-Americans, 44% of Hispanic-Americans, 24% of Asian-Americans and 33% of American Indians lacking proper medical insurance. In addition to that, more than 11 million (one quarter of the whole U.S.) were without medical insurance in 2003. Furthermore minorities received worse quality of health care services even if they are insured at the same level and pay the same premium. Research shows that black cancer patients don't receive the medicine and chemotherapy that the whites with the same disease receive. Another research tells us that minorities' women receive substantially less prenatal care as compared to the whites. These women are also given lesser services and information about the health care on their prenatal visits to the doctors. ("Unequal health," 2008)

Job structures:

The job structure in the U.S.A. also affects the medical services availed and their quality. The whites occupy more of the highly paid jobs that offer better health care insurance. The packages differ from job to job and the highly paid jobs get a large medical insurance as well. The communities of color in the U.S.A. take up lower paid jobs which offer no or very less medical insurance. Thus the insurance companies give a lesser amount per person to the colored community in the U.S.A. A research shows that Medicaid, a medical insurance company, paid above four thousand dollars per person on an average on the whites but the figures for other races was considerably low. The quality of health care is also affected by the job structures. The doctors providing services to the colored community have problems in accessing high quality diagnostics and surgeons. In one of the studies carried out on 300,000 patients treated in 123 hospitals, it was observed that patients of the colored community were treated in relatively lower quality hospitals. ("Unequal health," 2008)

Geographical reasons:

The geographical unavailability of medicines is also a major reason that causes medical disparities. Racial minorities tend to live in secluded and high deficiency areas. This causes the unavailability of medical supplies in the hospitals in their regions. A study about this matter showed that only 25% of the pharmacies in the minorities' regions consisted of the adequate supplies as opposed to 72% in the white regions. In addition to that, transport problems in these areas also trigger problems in getting medical aid. In another research, 18% Latinas and 10% African-American women were reported not getting medical aid due to transportation problems but the figure was quite low (5%) for the white women. Moreover, closure of hospitals in the non-white areas aggravates the whole problem. ("Unequal health," 2008)

Irregular health care services:

The racial minorities do not receive regular health care and this adds to the health care disparities. If a regular health service is available to the people, they can make good relationships with their practitioners and thus they can ask private questions. People, who don't get regular health care, get confused about telling the doctors their problems and thus they get frustrated when they don't get proper aid. Minorities don't get regular health care facilities and thus they are more prone to get confused in front of a medical practitioner. Since 2000, 42% of Hispanic poor and 37% of Hispanic well to do didn't get regular medical aid. In a study, it was detected that the reports of not having a regular medical service consisted one-third from whites and the rest from other racial groups. ("Unequal health," 2008)

Linguistic problems:

Another reason that triggers medical disparities is: language problems. Language plays an important part in expressing yourself to others. The problem, however, is that over 35 million people in the U.S.A. speak languages other than English. Of them, 10 million people do not speak English at all. Unfortunately not many health care institutes offer good interpretation services and this makes it difficult for the patients to tell the doctor what their problem is. This decreases the satisfaction that the patient gets from the medication and also increases the chance of medical errors and thus people become more reluctant towards getting medical help. In a research, it was found out that 20% of the non-English speakers avoid getting medical help due to problems in language. ("Unequal health," 2008)

Biased practitioners:

Doctor-patient interaction also adds to the health care inequalities. Both parties bring expectations at the time of the interaction. So, a part of these inequalities occurs due to the prejudice that the practitioners have about racial minorities. Although this seems less likely but experimental results show that doctors do keep negative thoughts about the patients from the non-colored community. The doctors have a perception that the racial minorities are more likely to be drug abusive and illiterate. They don't follow the doctors' instructions and aren't interested in any sort of therapy. Some doctors also find white people enjoyable, intelligent and worthy of friendship. These prejudices are unconscious but still they can alter the decisions of the doctor about what treatment to give (IOM report). Further studies show that these unspoken prejudices can cause the practitioners' decision to change. Another research assessed the biases and the doctors' verdicts of using thrombolysis on theoretical white or non-white patients suffering from a heart attack. Although the doctors didn't mention any explicit differences in both patients, the implicit association test (carried out by a computer) showed the other side of the picture. This test revealed a biased decision by the doctors who favored the white Americans and it also unveiled the implicit prejudices that the doctors were keeping against the black Americans. Despite of the fact that the practitioners unequivocally announced that they consider both the patients equal, their unspoken prejudices showed a probability that they will opt for thrombolysis for the white patient and not for the black one. ("Unequal health," 2008)

Suggestions for Better and Unbiased Heath Care System:

Providing equal health care facilities to all the individuals of the United States of America is a very difficult task. The objective of establishing an unbiased health care system is hindered by a number of barriers such as, poor information surrounding the health care system of the United States of America and an environment of distrust that is prevalent in the health care system. The efforts to minimize the racial disparities at a local level cannot eliminate such disparities completely. It should, therefore, be the foremost objective of the policy makers to devise strategies and plans that can eliminate such disparities entirely from the health care system. (Baicker, Chandra & Skinner, 2005)

Following steps should be taken by the government and policy makers to eliminate racial discrepancies from the health care system:

Improving Equal Provision of Medical Facilities:

Efforts should be made to provide minorities with equal health care facilities. This can be done by eradicating complex procedures from the institutions. In addition to that patients belonging to racial minorities should not be forced t wait for long times before getting an appointment with the doctor. Researches have also indicated that doctors do not treat patients belonging to racial minorities with respect and due to this disrespectable behavior people belonging to racial minorities avoid going to health care institutions unless it is really very necessary or the situation is very serious. If such issues that make the health care system unbearable for the racial minorities are eliminated then the issues of poor health will surely decrease in the United States of America. (Williams & Rucker)

High Quality Data System and Record Of Medical Care Quality:

In order to eliminate racial discrepancies from the United States health care system it is necessary to have an efficient data system. The quality of the medical care facilities should also be monitored continuously. There should be a standard for health care quality and it should be the same for both the minorities as well as the whites. United States health care system is going under a change and most of the health institutions have equipped efficient data recording systems and they also monitor the quality of health care very closely. (Williams & Rucker)

Better Implementation of Federal Laws in Health Care Institutions:

It has been recorded by different reports and researches that federal laws and regulations work best in the organizations that are dedicated towards implementing them and that accommodate such rules and regulations in their system. It has also been observed that there are a number of federal laws regarding health care discrepancies that are to be implemented in many health care institutions. In order to eradicate discriminations and disparities from the United States health care system it is necessary that federal laws are appropriately and timely implemented and followed in all the health care institutions of the United States of America. (Williams & Rucker)

Educated and Trained Workforce:

The workforce in the health care institutions should be trained and educated in way that they avoid discrimination. Training enables the practitioners to forego their primary believes that relate to racial discrimination and let them treat each patient with equal care, responsibility, respect and dedication. It is the arrogant and disrespectful behavior of the hospital administration and doctors that stops the racial minorities from approaching the health institutions unless the situation gets really adverse. If the workforce in the health care institutions is trained properly then they will treat the minorities appropriately. This will enable the minorities to approach the health care institutions comfortably without any hesitation. The proper training and education of workforce can reduce the poor health issues and mortality rate in the United States of America. It will also help the policy makers to achieve their objective of establishing an unbiased health care system in the United States of America. (Williams & Rucker)

Transformation of Current Health Care System:

Making changes in the health care system in order to eliminate health care discrepancies requires the policy makers to increase the coverage of different insurance programs. Their primary goal should be to provide insurance to those who are not insured as insurance facilitates the availability of appropriate medical care to great extent. And as discussed above, most of the people who are uninsured belong to the racial and ethnic minorities. So this provision of insurance coverage should be done purely on unbiased terms. In addition to that government and the policy makers should also monitor that the primary and basic medical and health care facilities should be available to each and every citizen of the United States of America irrespective of his/her cast, color or race. The government should also try to improve the standards and quality of patient centered systems. In addition to that the quality of health care facilities provided under different insurance programs should also be monitored and it should be altered and improved if necessary. ("A nation free," 2011)

Strengthening the Infrastructure of the United States Heath Care System:

This could be done by training the medical and health care professionals to identify the health care disparities and then to handle them effectively. Another problem persistent in the United States health care system is linguistic issue as different minorities speak different languages they are not able to interact with their doctors properly. According to a research most of the racial minorities claimed that they are not able to understand the instructions of their doctors. This issue can be addressed and eliminated if different health care institutions in the United States of America start hiring translators so that the minorities may feel at ease while talking to their doctor. ("A nation free," 2011)

Advancement in Health and Safety of the People of America:

As noted and discussed above there are some poor health issues that are peculiar only to the racial minorities or in other words racial minorities are effected the most by them. Such health issues include, Asthma, Hypertension, premature birth, adolescence pregnancy, diabetes, human immunodeficiency virus (HIV), infant mortality, breast cancer, cervical cancer, chronic heart diseases etcetera. The high rates of such diseases among the racial minorities are due to lack of information regarding such diseases. Government should carry out campaigns in order to train and educate minorities regarding such diseases and to teach them to take preventive measures against such diseases, ("A nation free," 2011)

Advancement in Technology:

Advancement in technology can also enable the government in eradicating the disparities from the health care system of the United States of America. Technological advancements can enable the officials to carry out better and extensive researches regarding health care discrepancies and discriminations hence they will be able to provide better measures to eliminate such disparities from the system. In addition to that technological advancements also enable the policy makers and the government to better monitor the standards and performance of the health care system by adopting efficient and effective equipments that can record and analyze each and every detail regarding this issue. ("A nation free," 2011)

Better and Effective Management:

Good and effective management of workforce and directive leadership can also enable the health institutions to eliminate health care issues and discrepancies. Good management lead towards better implementation of policies and issues in the organization and as discussed above better implementation of policies, procedures and laws will surely help in eliminating the disparities and discrepancies from the health care system.

Reinforcements, Rewards and Punishments:

Another issue related to the workforce is the enforcement of reinforcers (negative as well as positive), punishments and provision of rewards. Workforce is motivated by such incentives. If the organization or the health institution rewards their employees on the basis of their treatment with the racial minorities then this can surely lead towards elimination of disparities from the health care system of the United States of America.

Conclusion:

The American community has realized that the increasing and widening disparities in the health care system of the United States of America has been effecting the well being of the entire and highly diverse population of the United States of America. Researchers have indicated that the medical practitioners and professionals treat patients belonging to different races differently and their behavior with racial minorities is not fair. They keep them on a lower level regardless of their insurance policy, prescribed medicine, health issues and conditions, economic conditions and academic levels. It has also been observed that the biased beliefs of those working in the system also contribute towards the racial discrimination and disparities. It is said that these discrepancies can be eliminated by adapting and implementing appropriate strategies. ("Race, ethnicity, and," 2005)

It has also been indicated by researches that these health discrepancies are related with the socio economic status of the people. The health care conditions and socio economic status share an inverse relationship hence a decrease in one lead towards an increase in another and an increase in one will lead towards a decrease in other. Apart from that health insurances play an important role in improving the health conditions of the society. Government should design and implement policies that enable the health care system of the United States of America to reduce and eliminate discrepancies related to health insurance coverage and socio economic statuses. ("Race, ethnicity, and," 2005)

With advanced and detailed research government and policy makers can continue to collect relevant data and can find out the recent poor health issues and problems related to racial minorities and the factors that contribute towards the racial discrimination in the health care system of the United States of America. And with the help of these researches government can reduce and eliminate the racial disparities from the health care system of the United States of America. ("Race, ethnicity, and," 2005)

Reference