Healthcare Disparities Race Related

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)

How deeply are these Disparities rooted in the U.S. Health care System?

It has been acknowledged by a report of United States of America that a large number of racial and ethnic disparities are prevalent in the United States health care system.

Life expectancy Rate:

The report recorded that there was a decrease in the life expectancy gap of African-American and whites but still there are certain issues that must be noticed. For example, instead of this reduction in the life expectancy gap the life cycle of African-Americans is still six to ten years shorter than that of whites. In an analysis of 1991 to 2000 it has been claimed that if the life expectancy rate of African-Americans and whites would have been shifted to the same level almost 880,000 deaths would have been avoided. ("Unequal health," 2008)

Poor Health Problems:

Different racial and ethnic groups such as African-Americans, American Indians and Pacific Islanders suffer more poor health problems as compared to Asian-Americans and whites. These health problems include various diseases such as HIV Aids, cancer, cardiac arrest, diabetes etcetera.

The rates of poor health in different racial groups are higher than that of whites. American Indians complain of poor health problems twice as much as white. About 14.6% of blacks claim that they suffer from poor health whereas the percentage of white suffering from poor health is only 8%. Another racial group, Latinos, suffers greatly from diseases such as diabetes and is more likely to suffer from poor health as compared to whites. The graph below shows the percentages of different racial groups suffering from poor health as reported by National Health Interview Survey. ("Unequal health," 2008)

("Unequal health," 2008)

As shown in the graph whites suffer the minimum amount of poor health issues that is only 8%. The maximum poor health issues are faced by American Indians which is 16.5%.

The health status of various ethnic groups varies on the basis of their race, status and country of origin. For example, Hispanic men suffer from liver cancer and die due to it seven times more than white men. It has also been noticed that Vietnamese women suffer from cervical cancer the most as compared to any other racial or ethnic group. In addition to that the Mexican and Puerto Rican women are targeted by cervical cancer twice as more as white women. The highest rate of breast cancer prevails among the Hawaiians and most of the Filipinas die due to this disease. Breast cancer is said to be the major cause of death among the Filipinas. ("Unequal health," 2008)

Infant Mortality:

It is also recorded by the U.S. report that the infant mortality gap between the whites and blacks has increased. Though there has been a decrease in the rate of infant mortality but the infant mortality gap between African-Americans and blacks have increased up to 25%. Moreover, black infants are noted to have low birth weight two times more than white infants. Low birth weight is regarded as a major cause of infant mortality. The following figure shows the relationship between infant mortality and education of mothers. ("Unequal health," 2008)

("Unequal health," 2008)

It is quite evident from the above figure that the infant mortality rate declines with the increase in the education of mothers however this does not decrease the infant mortality gap between whites and blacks which has been increasing since last many years.

In addition to that colored women in United States of America suffer from a large amount of health problems. Their health conditions as compared to that of white women are quite adverse. One of the examples of their unfavorable health conditions is the high maternal mortality rate. The maternal mortality rate is highest among western nations. African women die four times more during child birth as compared to white women. This is because the colored, especially those belonging to low income families, do not have an access to the facilities that are necessary to get positive birth outcomes.

Medical Errors:

The medical errors in United States health care system cause about 44 to 98 thousand deaths. In addition to that, these errors also incur a loss of dollar 25 billion each year. Unfortunately due to high racial discrepancies most of such disadvantages are tolerated by the minorities. The minorities are comparatively more affected by surgical errors and complications. For example, blacks and Hispanics are more likely to be subjected to death due to errors during hospitalization than whites. Moreover, minorities are subjected to biased practices for example; black children face twice as more restraints while getting admitted at a psychiatric hospital than Whites. The situation is even worse in the case of Hispanics who face such restraints 70% more than whites. (Mead, Cartwright-Smith, Jones, Ramos & Siegel, 2008)

Timely Treatment:

Timely treatment of diseases can avert many deaths and they can also prevent prolonged disabilities. But unfortunately minorities are usually subjected to late treatments. Minorities are also likely to suffer from diseases that are caused by late treatment. For example, there are a very few chances that minorities may get the same or next day appointment. Most of the time they are given sixth or seventh day appointment. This delay in appointment can worsen the disease and can even cause death. However, it is also observed that this disparity decreases with the increase in the income. (Mead, Cartwright-Smith, Jones, Ramos & Siegel, 2008)

In minorities the diseases that can be prevented and cured by early diagnosis are not properly analyzed and this delay in analysis causes death. For example, Hispanics, among all the minorities, are least likely to be diagnosed in case of cancer and colorectal cancer. (Mead, Cartwright-Smith, Jones, Ramos & Siegel, 2008)

Patient Centered System:

In order to get better outcomes the health care system should be patient centered. A patient centered care system however, requires fluent and efficient communication between patients and doctors. Minorities have complains in this regard too as most of the blacks and Hispanics complain that are not able to communicate easily with their doctors. People who are not native English speakers claimed that their doctors do not listen to what they say and they do not even explain things clearly to them. In addition to that they also reported that their doctors do not respect what they say.

Chronic Heart Diseases:

The major and leading cause of deaths in the United States of America is Heart diseases. The minorities again suffer from heart diseases disproportionately. According to a report of Centers for Disease Control (CDC), in the year 2006 Chronic Heart Diseases (CHDs) were the cause of about 425,425 deaths of people belonging to all age groups. Most of the people dying due to chronic heart diseases belonged to black racial group. The rate of white people dying due to CHD was greater than that of American Indians. About 137,119 died due to stroke according to this report. The rate of Blacks dying due to heart stroke was 32.7% more than that of whites. Hispanic had lower rates than whites. Premature deaths due to strokes were also analyzed under this report and the data recorded was as follows, about 39% of black women died before reaching seventy five years of age which is quite high as compared to 17.3% of white women. The percentage of black men dying prematurely due to stroke was 60.7 whereas, 31.1% white men died before reaching the age of seventy five years due to stroke. ("CDC health disparities," 2011)

Asthma:

About 7.8% of the total United States population was suffering from Asthma when examined during the year 2006 and 2007. The prevalence of Asthma in racial minorities was greater than that of Whites. The percentage of multicultural people suffering from Asthma was noted to be 14.8%. About 14.2% of Puerto Rican Hispanics people were suffering from Asthma. The rate of Asthma among blacks was 9.5% and Whites had the lowest rate of Asthma which was 7.8%. It was also reported that women with a rate of 8.6% suffered more from Asthma than men who had a rate of 6.9%. The people belonging to different economic statuses also had varying rates of Asthma with poor people having a rate of 11.2%, those who were nearly poor had a rate of 8.4% and non-poor people or stable people had a rate of 7.0%. ("CDC health disparities," 2011)

Human Immunodeficiency Virus (HIV):

According to the current analysis about eleven hundred thousand people in the United States of America are infected with the dangerous Human Immunodeficiency Virus (HIV). The amount that became infected with this virus each year ranges between 48,200 to 64,500. In case of AIDS racial discrimination in health care system was quite clear. The percentage of black people infected with HIV is 1831%, for Hispanics the rate was 359%, the rate of infection among white people was 266%. The rate was 310% for people belonging to multiple races. American Indians had a rate of 138%. However, Asians had the lowest rate of human immunodeficiency virus, which was 6%. It is quite evident from the above figures that apart from Asians all other racial and ethnic minorities continue to suffer AIDS at a rate which is quite higher than that of Whites. ("CDC health disparities," 2011)

Diabetes:

Diabetes is one of the major but preventable health problems in the United States of America. It has been increasing since last few years and it was noted that the racial and ethnic minorities and the groups that are not socioeconomically stable suffer most of its adverse effects. About 7.7% of White men were diagnosed with diabetes whereas; the rate for black men was 9.6%. The same condition prevailed among the women as the rate for white women was 5.4%, for black women it 7% and the highest rate prevailed among Hispanic women, which was 14.6%. ("CDC health disparities," 2011)

Hypertension:

An analysis was made to survey people suffering from hypertension. The report recorded the following results; the rate for white people suffering from hypertension was 28.8%. About 25.5% of Mexicans were diagnosed with. The highest rate of hyper tension prevailed among Blacks or African-Americans, shooting up to 42%. ("CDC health disparities," 2011)

Relationship Between Socioeconomic Status and Health:

Upon analysis it was reported that in the United States health care system there is an inverse relationship between socioeconomic status and health. An increase in economic status leads towards a decrease in health issues whereas, a decrease in socioeconomic status leads toward an increase in health issues. A persuasive indicator of this relation is the mortality rates. It was revealed by the data of National Longitudinal Mortality Study that an increase in the level of education and income is related with a decrease in mortality rates. It is observed that black people, both male and female, who have an annual income of dollar 5000 have mortality two times more than those who have a yearly income of dollar 50,000 and more. Researches have also indicated that there is a negative relation between psychiatric problems and socio economic status. It was reported that high socioeconomic status is associated with less psychiatric problems and low socioeconomic status was associated with more psychiatric problems. The preceding pattern was noticed in both black and white people. This indirect relation between health issues and socio economic status has been increasing greatly and the reason behind it is the difference that low and high socioeconomic groups face while getting treated, assessing medical treatment and getting appropriate care. It is, for example, observed that mortality rates due to breast cancer among low socioeconomic groups are far greater than that of high socioeconomic groups. (Williams, Collins, 1995)

Correlation between Race and Socioeconomic Status:

The primary cause of disparities in the United States health care system is the difference of socioeconomic status of different racial groups. Race and socioeconomic status have a strong relationship. It was observed that the poverty rate among white people is 11%. Blacks had a poverty rate of 33% and the poverty rate among Hispanics is 29%. It was also recorded that children who are born in families, which have an annual income of dollar 10,000 or less, are 4.6 times more likely to be affected with poor birth health than the children who are born in families with an annual income of dollar 35,000 or more. Moreover, it was also found that among all the socioeconomic levels black people generally have more health issues than white people. (Williams & Collins, 1995)

It was also observed in a study that black people belonging to low socioeconomic status had high rates of depression as compared to the white belonging to the same social class. The situation was same in the case of substance abuse among women. Black women belonging to low socioeconomic status had a high rate of substance abuse in relation to the white women of the same class. It is evident from the above facts that there is strong association between race and socioeconomic status. It has also been observed that if race is adjusted with socioeconomic status then the disparities caused by racism can be reduced. By applying this technique we can somehow reduce such disparities but we cannot completely eliminate them from our society. (Williams & Collins, 1995)

Association between Health and Health Insurance:

There is a positive relationship between health insurance and contact with medical services. It has been observed that insurance facilitates the procedure of getting medical facilities. It enables the people to get timely and good quality treatment and improves the quality of health. It has also been observed that uninsured people face more poor health issues and problems as compared to the insured ones. It has been proven by a number of researches that lack of insurance lead towards deteriorating health as people are not able to get better treatment and if treated then they are not able to afford prescribed medicine. (Devi, 2005)

It has also been observed in a research that women who do not have insurance avoid going to a hospital for regular checkup as they find standing in a line, filling a form and waiting for a doctor very tiresome. In addition to that insurance also has an impact on infant mortality. A study reported that uninsured babies are more likely to be affected by poor health issues than the babies who are insured. The study also reported that the chances of death for uninsured babies are 1.5 times greater than those babies who are insured. It has also been observed by researches that people who are not insured for a period of four years or more are likely 1.6 times more likely to suffer from adverse health problems including death than those who are insured continuously. For those who are insured temporarily for different intervals of time are 1.4 times more likely to suffer adverse health problems than those who are continuously insured. Uninsured people also complained that due non-availability of timely treatment they have suffered partial disability 47% of time. The rate of complete disability among uninsured people is 19%. (Devi, 2005)

By having insurance the rate of mortality among uninsured people can reduced up to 10 to 15%. Insurance enable them to get timely and appropriate medical care 50% of the time and having timely medical care about 50% of the time reduces mortality rates by 10 to 15%. (Devi, 2005)

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)