Would Universal Access Help Health Disparities?

We know that there are fundamental inequalities in our health care system, and many of them hit communities of color and different socio-economic backgrounds the hardest. Even worse, the conclusion of a report by the Agency for Healthcare Research and Quality in 2007 is that this gap isn’t getting any closer. For every indicator where we’ve eliminated disparities, like hospital admissions for perforated appendix, many more have stayed exactly the same, or have gotten much worse, like the rate of new AIDS cases for Blacks and Latinos compared to Whites. Not all of these problems would be automatically solved by equal access to health care for all – but it would be a damn good start.

We know that income is a good indicator of how likely a family is to be uninsured, even for the 80% of uninsured where one or more family members work full-time.   AHRQ cites these these numbers from 2004: “Among people under age 65, 14% of non-Hispanic Whites were uninsured for the whole year, but the figure climbs to 29% for Hispanics, 15% for non-Hispanic Blacks, and 12% for Asians.” But there’s an access gap that transcends income.  A recent Families USA report shows that “families earning more than $84,800 annually were more likely to be uninsured if they were racial and ethnic minorities.  In this income group, almost one-third of Hispanics/Latinos (32 percent), nearly one-fourth of African Americans (23.6 percent), and one-fifth of other racial and ethnic minorities (20.8 percent) lacked coverage, compared to 16 percent of whites.” Suffice to say, these are overwhelmingly families where one or both parents work for companies that do not offer benefits and families who, for whatever reason, can’t afford to have 14% of their pre-tax income go to an “affordable” health plan (or possibly are denied access to a plan because of pre-existing conditions.)  There are obviously major health problems that come from lack of access – preventative care often goes out the window, early screening for complex chronic diseases like AIDS, cancer, diabetes, hypertension and heart disease go out the window, meaning they get treated much later.  It’s not just more expensive, it’s downright deadly.

A new report in the Annals of Internal Medicine confirms what you would suspect: after 65, some of these disparities in care disappear, and in others, the gap becomes much more narrow.  Med Page Today has a write-up of the findings from a study of black and white patients classified in age groups of 40-65 and 65-and-older: “differences in blood pressure, glycated hemoglobin, and serum cholesterol in black versus white patients were significantly smaller among those over 65 compared with younger people.” The study is quick to say that this indicates better management of the chronic disease, not necessarily prevention of the condition. Still, it means people from at-risk communities on Medicare are doing a better job of controlling their condition. Not for nothing, they also have a higher likelihood of having a primary care physician, being properly instructed on how to manage their condition, and less likely to wait until their pain or discomfort is unbearable before seeking out care. The verdict according to editorialist Dr. Ashwini R. Sehga is clear: although not a cure-all, "On the one hand, [the] findings add to existing evidence indicating that simply improving quality of care will not eliminate disparities. On the other hand, their findings suggest that covering the uninsured is key to reducing the sizable and persistent disparities in our country.”

No doubt this is the beginning not the end of dealing with disparities in care. Smart investments in translation services (there’s a big difference between speaking English as a second language at work and giving clear medical answers in English when you’re bowled over in pain and stressed out), cultural education of health care workers, chronic disease management, and re-thinking how we finance medical school education are all necessary components of tackling the problem. But it’s clear some disparities we can’t begin to solve until we have quality, affordable health care for all.

(Photo credit:  maiqui maiqui on Flickr.)