As I explained in part one of this series of posts, minority racial and ethnic groups in the United States experience widespread and severe disparities in healthcare. Over the last few years, I have dedicated my time to researching health and treatment disparities in America that affect racial minorities. The COVID-19 pandemic has only exaggerated the issues, and I therefore feel that it is prudent to explore some of my research in multiple posts.
In order to reform the healthcare system in a way that will finally achieve equality, a deep understanding of the barriers contributing to unequal access and care is required. This is where we left off last time, so I will now delve into the logistical side of these barriers. The first of these contributors is low socioeconomic status and insurance issues. According to a literature review from the Kaiser Family Foundation, health insurance was the single most significant factor explaining racial disparities in having a usual source of care, and uninsured adults among all racial/ethnic groups were twice as likely to go without a doctor visit in the past year (National Research Council, 2004). Although other racial/ethnic groups face an even larger disparity in levels of insurance coverage, still 19% of black Americans are uninsured compared to 10% of whites (American College of Physicians, 2010).
Prospects have improved with the implementation of Medicare and Medicaid, but many barriers to equal care remain. Medicare does not cover prescription drugs, dental care, or long-term care and imposes other out-of-pocket medical expenses such as deductibles and copayments on appointment charges. The addition of Medicaid can offset some of these charges, but less than 15% of Medicare beneficiaries are able to receive both (National Research Council, 2004). Additionally, not all doctors accept these forms of insurance. Relying on specific providers can lead to horrible waiting times for appointments, inefficient intake of patients, lower quality of care, and major problems getting referrals to specialists. With the colossal charges associated with medicine in the United States, it is easy to see why lack of insurance would force one into bankruptcy or lead to avoidance of medical care in the first place.
The lower levels of socioeconomic status (SES) of minorities has many implications for access and quality of health care besides through its effect on insurance level. Black Americans are the poorest ethnic group in the United States with the lowest median household income in the USA for the past 50 years (Noonan et al., 2016). The negative effects of poverty on health are numerous and include lack of clean water, clothing, shelter, education, and nutrition. It is known that poverty is highly correlated with poor health outcomes and poorer individuals have higher levels of heart disease, obesity, elevated blood lead levels, low birth weight, and many other issues (Noonan et al., 2016). However, lower SES that is still far above the poverty line can contribute to health disparities in less obvious ways. Those with lower incomes tend to live in worse neighborhoods with higher rates of violence and crime, lower quality of shelter, water, and food, and less numerous and viable options for good medical care (Pathman, Fowler-Brown, & Corbie-Smith, 2006). Additionally, low-income jobs usually involve longer hours and more dangerous working conditions. Long hours may be a hidden factor in one’s ability to visit a doctor or urgent care during doctors’ working hours, and dangerous working conditions obviously contribute to injuries and poor health outcomes (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003). While the structural barriers of insurance and low SES are huge, a discussion of cultural differences is required as well—stay tuned for this discussion in a later post.