Economic Impact Of Health Insurance: A Look At European Case Studies – The COVID-19 pandemic and the national racial justice movement of the past few years have increased the focus on health disparities and their underlying causes and contributed to the increased priority of health equity. These disparities are not new and reflect longstanding structural and systemic inequalities rooted in racism and discrimination. Although growing efforts have recently focused on addressing disparities, the end of several policies implemented during the COVID-19 pandemic, including continued enrollment for Medicaid and the Children’s Health Insurance Program (CHIP), can reverse progress and widen disparities. Addressing health disparities is not only important from an equity perspective, but also for improving the overall health and economic prosperity of the country. This brief provides an introduction to what health and health care disparities are, why it is important to address disparities, what the status of disparities is today, recent federal actions to address disparities, and key issues that related to addressing future differences.
Health and health care disparities refer to differences in health and health care between groups that arise from broader inequalities. There are many definitions of health disparities. Healthy People 2030 defines a health disparity, as “a specific type of health disparity related to social, economic, and/or environmental disadvantage,” and adversely affects groups of people who are systematically experienced greater health barriers. The Centers for Disease Control and Prevention (CDC) defines health disparities as, “preventable differences in the burden, disease, injury, violence, or opportunities to achieve optimal health experienced by people with disabilities in society, ethnic, and other population groups and communities. ” Health care disparity generally refers to differences between groups in health insurance coverage, affordability, access to and use of care, and quality of care. The terms “health inequity” and “inequality” are also sometimes used to describe unjust differences. Racism, defined by the CDC as structures, policies, practices, and norms that assign value and define opportunities based on people’s appearance or the color of their skin, results in conditions that unfairly benefit some and harmful to others, putting people of color. at greater risk for poor health outcomes.
Economic Impact Of Health Insurance: A Look At European Case Studies
Health equity generally refers to individuals achieving their highest level of health by eliminating disparities in health and health care. Healthy People 2030 defines health equity as the achievement of the highest level of health for all people and states that it requires equal valuing of all with focused and sustained societal efforts to address these avoidable inequalities, historical and contemporary injustices, and disparities in health and health care. The CDC describes health equity as when everyone has the opportunity to be as healthy as possible.
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A wide range of factors inside and outside the health care system drive health care and health disparities (Figure 1). Although health care is important to health, research shows that health outcomes are driven by many factors, including underlying genetics, health behaviors, social and environmental factors, and access to health care. Although there is currently no research consensus on the magnitude of the relative contributions of each of these factors to health, studies suggest that health behaviors and social and economic factors, often referred to as the social determinants of health, are the primary causes of health. outcomes and social and economic factors shape the health behaviors of individuals. Moreover, racism negatively affects mental and physical health directly and by creating inequities in the social determinants of health.
Disparities in health and health care are often viewed through the lens of race and ethnicity, but they occur on a wide range of scales. For example, differences occur in socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Research also suggests that differences occur throughout the life course, from birth, through midlife, and into adulthood. Federal efforts to reduce disparities have focused on designated priority populations, including, “members of underserved communities: Black, Latino, and Indigenous and Native American people, Asian American and Pacific Islanders and other people of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBT+) people; people with disabilities; people living in rural areas; and people affected by persistent poverty or inequality.” These groups are not mutually exclusive and often intersect in significant ways. Differences also occur within subgroups of populations. For example, there are differences among Hispanic people in health and health care based on length of time in the country, primary language, and immigration status. The data also often mask underlying differences among subgroups within the Asian population.
Addressing health and health care disparities is important not only from an equity perspective but also for improving the nation’s overall health and economic prosperity. People of color and other underserved groups experience higher rates of illness and death across a wide range of health conditions, limiting the nation’s overall health. Research has even found that health disparities are costly, resulting in excess medical care costs and lost productivity as well as additional economic losses due to premature deaths each year.
It is increasingly important to address health disparities as the population becomes more diverse and income inequality continues to grow. People of color are expected to make up more than half (52%) of the population by 2050, with the greatest growth occurring among people who identify as Asian or Hispanic (Figure 2). Over time, the population has become increasingly racially diverse, reflecting changing immigration patterns, growing multiracial populations, as well as adjustments in how the federal Census Bureau measures race and ethnicity. Over time, income inequality within the U.S. has also widened. In 2021, the richest 20% of households accounted for more than half of aggregate household income and had an income of $149 , 132 or higher compared to the lowest 20% of households worth less than 3% of combined household income and with incomes of $28,007 or less. The top 5 percent of households in the income distribution have incomes of $286, 305 or more. Research suggests that the disparate negative impact of the COVID-19 pandemic on low-wage jobs may have long-term effects that contribute to further widening income inequality in the long term.
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Disparities in health and health care are persistent and widespread. Major recognition of health disparities began more than three decades ago with the Report of the Secretary’s Task Force on Black and Minority Health (Heckler Report) in 1985, which documented persistent health disparities reaching 60,000 excess deaths each year and synthesize ways to advance health equity. The Heckler’s Report led to the creation of the U.S. Department of Health and Human Services Office of Minority Health and influenced federal recognition and investment in many aspects of health equity. In 2003, the Institute of Medicine’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care released the report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which identified systemic racism as a major cause of health disparities in United States. . Despite recognition and documentation of disparities over decades and overall improvements in population health over time, many disparities persist, and, in some cases, have widened over time.
Despite significant increases in coverage since the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014, people of color and other marginalized and underserved groups remain more likely to be uninsured. Racial disparities in coverage persisted in 2021, with higher uninsured rates for non-elderly American Indian or Alaska Native (AIAN), Hispanic, Black, and Native Hawaiian or Pacific Islander (NHOPI) individuals. people compared to their White counterparts (Figure 3). Other groups also remained at higher risk of being uninsured, including immigrants and people in lower-income families. Many uninsured people qualify for coverage through Medicaid, CHIP, or the ACA Marketplaces but face barriers to enrollment including confusion about eligibility rules, difficulty navigating enrollment processes, and language and literacy problems. Some immigrant families also have immigration-related fears about enrolling themselves or their children in Medicaid or CHIP even if they are eligible. Others remain ineligible because their state has not expanded Medicaid, because of their immigration status, or because they have access to an affordable Marketplace plan or employer coverage offer.
Beyond coverage, people of color and other marginalized and underserved groups continue to experience multiple disparities in accessing and receiving care. For example, rural people face barriers to accessing care due to low density of providers and longer travel times to care, as well as more limited access to health coverage. There are also inequalities in the experiences of receiving health care across groups. For example, /The Undefeated 2020 Survey on Race and Health found that one in five Black adults and one in five Hispanic adults report being treated unfairly because of their race or ethnicity while obtaining health care for themselves. or a family member in the past year. Nearly a quarter (24%) of Hispanic adults and more than one in three (34%) potentially undocumented Hispanic adults report that it is very difficult or somewhat difficult to find a doctor who explains it in a way that is easy to understand in a 2021
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