Disparities in US Healthcare System

Healthcare disparities pose a major challenge to the diverse 21st century America. Demographic trends indicate that the number of Americans who are vulnerable to suffering the effects of healthcare disparities will rise over the next half century. These trends pose a daunting challenge for policymakers and the healthcare system. Wide disparities exist among groups on the basis of race/ethnicity, socioeconomic status, and geography. Healthcare disparities have occurred across different regional populations, economic cohorts, and racial/ethnic groups as well as between men and women. Education and income related disparities have also been seen. Social, cultural and economic factors are responsible for inequalities in the healthcare system.

The issue of racial and ethnic disparities in healthcare have exploded onto the public stage. The causes of these disparities have been divided into health system factors and patient-provider factors. Health system factors include language and cultural barriers, the tendency for racial minorities to have lower-end health plans, and the lack of community resources, such as adequately stocked pharmacies in minority neighborhoods. Patient-provider factors include provider bias against minority patients, greater clinical uncertainty when treating minority patients, stereotypes about minority health behaviors and compliance, and mistrust and refusal of care by minority patients themselves who have had previous negative experiences with the healthcare system.

The explanation for the racial and ethnic disparities is that minorities tend to be poor and less educated, with less access to care and they tend to live in places where doctors and hospitals provide lower quality care than elsewhere. Cultural or biological differences also play a role, and there is a long-running debate on how subtle racism infects the healthcare system. Inadequate transportation or the lack of knowledge among minorities about hospital quality could also be factors of inadequate care. Racial disparities are most likely a shared responsibility of plans, providers and patients. There’s probably not one factor that explains all of the disparity, but health plans do play an important role. Racial and ethnic disparities in healthcare do not occur in isolation. They are a part of the broader social and economic inequality experienced by minorities in many sectors. Many parts of the system including health plans, health care providers and patients may contribute to racial and ethnic disparities in health care.

It is seen that there are significant disparities in the quality of care delivered to racial and ethnic minorities. There is a need to combat the root causes of discrimination within our healthcare system. Racial or ethnic differences in the quality of healthcare needs to be taken care of. This can be done by understanding multilevel determinants of healthcare disparities, including individual belief and preferences, effective patient-provider communication and the organizational culture of the health care system.

To build a healthier America, a much-needed framework for a broad national effort is required to research the reasons behind healthcare disparities and to develop workable solutions. If these inequalities grow in access, they can contribute to and exacerbate existing disparities in health and quality of life, creating barriers to a strong and productive life.

There is a need to form possible strategies and interventions that may be able to lessen and perhaps even eliminate these differences. It is largely determined by assumptions about the etiology of a given disparity. Some disparities may be driven, for example, by gaps in access and insurance coverage, and the appropriate strategy will directly address these shortcomings. The elimination of disparities will help to ensure that all patients receive evidence-based care for their condition. Such an approach will help establish quality improvement in the healthcare industry.

Reducing disparities is increasingly seen as part of improving quality overall. The focus should be to understand their underlying causes and design interventions to reduce or eliminate them. The strategy of tackling disparities as part of quality improvement programs has gained significant attraction nationally. National leadership is needed to push for innovations in quality improvement, and to take actions that reduce disparities in clinical practice, health professional education, and research.

The programs and polices to reduce and potentially eliminate disparities should be informed by research that identifies and targets the underlying causes of lower performance in hospitals. By eliminating disparities, the hospitals will become even more committed to the community. This will help to provide culturally competent care and also improve community connections. It will stimulate substantial progress in the quality of service that hospitals offer to its diverse patient community. Ongoing work to eliminate health disparities will help the healthcare departments to continually evaluate the patient satisfaction with services and achieve equality in healthcare services.

It is important to use some interventions to reduce healthcare disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. This will help in ensuring community commitment and serve the health needs of the community.

There is the need to address these disparities on six fronts: increasing access to quality health care, patient care, provider issues, systems that deliver health care, societal concerns, and continued research. A well-functioning system would have minimal differences among groups in terms of access to and quality of healthcare services. This will help to bring single standard of care for people of all walks of life.

Elimination of health care disparities will help to build a healthier America. Improving population health and reducing healthcare disparities would go hand in hand. In the health field, organizations exist to meet human needs. It is important to analyze rationally as to what actions would contribute to eliminate the disparities in the healthcare field, so that human needs are fulfilled in a conducive way.

Meenu Arora has contributed her articles for both online and hard copy magazines. Her articles have also been published in international magazines. Presently working in the healthcare industry, she has also written and edited Health Q-A columns for international magazine for 5 years.

Cynicism or a Healthcare System That Needs Help

This story is about a patient with no real experience in the healthcare system.

A patient was having some sinus issues in December of 2012. Basically, mucus had settled into his sinus cavities. It was like talking in a tunnel and difficult for him to hear.

To get relief, he started with his family doctor in December. The family doctor prescribed some antibiotics-a fast, powerful dose. After a month, experiencing no relief, he went back. The doctor prescribed more medication. No relief. He sent the patient to an Ear, Nose and Throat (ENT) specialist.

The ENT prescribed steroids. He claimed that cured 80% of the individuals with this problem. The patient had high hopes but the steroids did not work, either.

The ENT recommended a CT scan at the hospital. After much searching and aggravation, the patient found out it would be about $2,500 (Note: the patient did have insurance but had a $2,500 deductible and 20% co-insurance). He shopped around (an arduous process) for a clinic to get a price. He found one that would do the sinus CT scan for $400.

The CT scan confirmed everything. The sinuses should have been black (denoting air) but they were gray (denoting mucus).

The doctor recommended a sinusplasty. This is a procedure where the sinus passageways are stretched to allow for draining. A balloon is inflated to allow this to happen. The mucus present would be sucked out through a kind of straw. It was an outpatient surgery, taking about 1.5 hours. It was scheduled for May 31st. The patient said ok.

Of course, prior to the surgery tests had to be done (really?). A blood test, chest x-ray and an EKG. The EKG was because the procedure included a general anesthetic.

The nurse called him two days prior to surgery. The tests were fine. But the EKG indicated a Myocardial infarction (MI)-age undetermined. That meant the patient had experienced a heart attack sometime in his past.

What???

The patient was stunned. Other than being overweight, he had no health issues. If he had a heart attack, he was not aware of it. It didn’t matter. The surgery was cancelled until the patient could obtain cardiac clearance. He had to see a cardiologist to get that.

After an exam, the doctor told the patient, he probably didn’t have a heart attack. The EKG was faulty. The machines were sensitive and could give a false reading pretty easily (the patient was of course, still charged for it).

After another EKG and a heart echo sound, the doctor confirmed there was no attack and that, in fact, the patient’s heart was hale and hearty.

Cardiac clearance was received and the surgery rescheduled for July.

While everyone seemed to mean well, was all of this really necessary? Are all of these doctor’s visits, tests and medications normal? The patient is not cynical by nature but…

Sue (Sunni) Patterson, CMBA, Co-Founder
As an accomplished marketing professional, entrepreneur and lifelong learner, Sunni constantly seeks out dynamic business opportunities. Sunni started in the healthcare industry as a senior medical claims processor with a major insurance payer and since then has partnered with RMK123.com, a top medical billing and revenue management firm. Sunni leveraged this to create Medical Bill & Claim Resolution (MBCR), a medical bill patient advocate firm assisting individuals with interpreting their medical and hospital bills, disputing erroneous charges and resolving/understanding insurance claim decisions. Sunni holds the specialist Certified Medical Billing Advocate (CMBA) designation, which is issued through the Medical Billing Advocates of America upon successful completion of their exam.