Why Do People Care about Healthcare Reform?

Some Don't Get the Right Care

Some groups of Americans do not get the right healthcare even if they have insurance.

Blacks, for example, get less healthcare (Fiscella, et al., 2002) and have worse health outcomes (Karter, et al., 2002) than white Americans, even if black Americans have the same health insurance. People who have greater than an hour’s travel time to get to the care they need—whether they live in rural communities or cities--are less likely to get the health services they need (Onega, et al., 2008). Women do not get the same quality care or have the same health outcomes as men treated for the same conditions (AHRQ, 2009). People with disabilities get lower quality care and have worse health outcomes than other people (McCarthy, et al., 2006).

The reasons for these differences even among insured Americans are not completely clear, but may include:

• that minorities are often treated at lower quality hospitals (Hasnain-Wynia, et al., 2007); and
• that healthcare providers hold different attitudes toward women, minorities, and people with disabilities than they do toward men, whites, and people without disabilities (van Ryn and Burke, 2000; Iezzoni, 2009).

Differences in health outcomes between groups may also be a result of differences in income and education. Higher income and more education are known to result in better health, even when coverage and services are the same (Marmot, 1999), and minorities and people with disabilities have lower incomes and less education overall (Williams, 1999; Umansky, 2004).

Sources

Fiscella, Kevin, Peter Franks, Mark P. Doerscher et al. 2002. Disparities in Health Care by Race, Ethnicity and Language among the Insured: Findings from a National Sample. Medical Care 40(1): 52-59. www.hss.ucsf.edu/PDF/article-Ethnic%20diff%20in%20complications%20JAMA.pdf.

Onega, Tracy L., E.J. Duell, X. Shi et al. 2008. Geographic Access to Cancer Care in the U.S. Cancer 112(2): 909-918. www.ncbi.nlm.nih.gov/pubmed/18189295?dopt=AbstractPlus.

AHRQ, Cardiovascular Disease and Other Chronic Conditions in Women: Recent Findings. Program Brief. AHRQ Publication No. 09-PB005, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/womheart.htm

McCarthy, E.P., L. H. Ngo, R. G. Roetzheim et al. 2006. Disparities in Breast Cancer Treatment and Survival for Women with Disabilities. Annals of Internal Medicine 145(9): 637-645. www.ncbi.nlm.nih.gov/pubmed/17088576.

Hasnain-Wynia, Romana, David W. Baker, David Nerenz et al. 2007. Disparities in Health Care Are Driven by Where Minorities Seek Care: Examination of Hospital Quality Alliance Measures. Annals of Internal Medicine 167:1233-1239.http://www.hret.org/about/resources/biennial07.pdf

van Ryn, Michelle and Jane Burke. 2000. The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients. Social Science and Medicine 50(6): 813-828.

Iezzoni, Lisa I. 2009. Testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions, January 27. www.asph.org/UserFiles/Iezzoni.pdf.

Marmot, Michael.  1999.  Multi-level Approaches to Understanding Social Determinants.  In Lisa Berkman and Ichiro Kawachi, eds.,  Social Epidemiology.  Oxford:  Oxford University Press.

Williams, David R.  1999.  Race, Socioeconomic Status and Health. Annals of the New York Academy of Sciences.  www.echt.chm.msu.edu/BlockIII/Docs/RecRead/RaceSocioeconomic.pdf.

Umansky, Lauri.  2004.  Disability.  In Gwendolyn Mink and Alice O’Connor, eds., Poverty in the United States:  An Encyclopedia of History, Politics and Policy, volume 2.  New York:  ABC-CLIO. 

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