Healthcare is a social justice issue, mainly when focusing on how health is provided in the United States. Over the years, the cost of healthcare in the United States has been a concern, especially to the public. The high cost of care means that only wealthy individuals can access quality healthcare, while the poor sometimes cannot afford the high cost, or if they do, they do not receive quality healthcare services. Nevertheless, healthcare in the United States is not just about how affordable it is, but also there are prevalent inequalities in how various groups of people receive care. One of the starkest differences relates to how the white majority receive care compared to the minority groups, such as African Americans, Latino, and Native Americans (Mossialos et al., 2016). Focusing on a country like Australia, which is considered to be a developed country just like the United States, it has better health outcomes, because of the existence of a universal health coverage program and favorable health policies. All social groups in Australia, including the minority Aboriginal people, can access essential health care services without worrying too much about running bankrupt. The healthcare system in Australia is funded by the national government, state, and local authorities, as well as private health insurance companies. All these entities fund healthcare and make it much more affordable than it is in the United States. For the United States, healthcare is mainly financed by private insurance companies, and there is no proper regulation to control the skyrocketing prices of healthcare services.
Although there have been considerable improvements in the provision of healthcare over the years, social discrimination in the United States remains to be a significant factor in the incessant adverse health outcomes by ethnic and racial minorities in the country. D’Anna et al. (2018) define social discrimination as the differential treatment of particular groups of people based on their perceived or actual characteristics such as age, ethnicity, race, gender, medical condition or income status. In the context of healthcare, such treatment manifests in the form of behaviors, opinions, beliefs, as well as attitudes of clinicians that could impact disadvantaged populations negatively. A good example is when a healthcare provider withholds a full range of treatment options from specific patients because of their personal conscious or unconscious perceptions that such patients are less likely to embrace or follow specific therapies.
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According to a study conducted by D’Anna et al. (2018), from a sample of the feedback given to the Behavioral Risk Surveillance System (2005-2013) from respondents who received healthcare services in the previous 12 months, the comparable probability of reporting discrimination against equal treatment was nearly four times for Black people, while Whites of Hispanic origin had a 50% higher probability of reporting discrimination in comparison to non-Hispanic Whites. Subsequently, health-compromising outcomes linked with social discrimination comprise of increased risk of physical stress respondents, patient disengagement, non-compliance or poor compliance with medical treatment guidelines, and healthcare avoidance attitudes. Consequently, these outcomes cause higher mortality and morbidity rates, which are prevalent among minority groups. On the same note, a national survey exposed that 65% of non-Hispanic White patients expressed satisfaction with the quality of care they received, while only 45% of Asian and 56% of Hispanic patients expressed their satisfaction with the quality of healthcare services they received from the years 2016 to 2018 (D’Anna et al., 2018). Although sometimes self-reported statistics could attract considerable critics, they inevitably portray an overview of the inherent problems of the United States healthcare system. The objective of this essay is to demonstrate that despite the U.S. investing in healthcare significantly, accessibility and affordability is still a problem, but the country can still improve the system by emulating some aspects of the Australian healthcare system.
Literature Review
Medical sociologists have striven to create an understanding of the way healthcare services are delivered in the United States for many years. Wright& Perry(2010) provide key findings of healthcare delivery in the United States across the years. The first finding is that healthcare in the United States is unequally distributed, and that contributes to health inequalities across different groups of individuals. The unequal distribution of healthcare means bias in the distribution of resources among the different groups. Literature suggests the better distribution of healthcare resources among neighborhoods with the majority of whites compared to residential places of minority groups, especially those of Blacks and Latino (Boulware et al., 2016). Better healthcare outcomes are also associated with equal distribution of infrastructural facilities, especially roads. In case of emergency medical needs, ambulances, and other evacuation services have to get easy access to the areas to provide healthcare services to the patients in critical conditions. The typical situation in the United States is that inner cities, which usually have majority Black groups or Latinos, are often congested and lack essential infrastructure and healthcare amenities. In the event of a fire accident, it would be relatively hard to access some of the inner cities compared to residential neighborhoods of White majority groups.
Another aspect that affects how minority groups receive healthcare services relates to socio-economic disposition. Most of the minority racial and ethnic groups in the United States are low-income earners. Therefore, structural issues inherent in the American system probably were never meant to address the needs of the minority groups. Racial discrimination, which has been reported over the years, affects the type of occupations in which minority groups participate(Abramson et al., 2015). For instance, it is common knowledge that African Americans were treated as slaves in the past years in America. Although constitutional changes might have been made to address the question of equality, the design of the system might have been made to ensure that they do not get equal opportunities. Consequently, minority groups are likely to work in low-income occupations, which make it quite a challenge to afford expensive healthcare services. A study by Abramson et al. (2015) reveals that minority groups, especially African Americans and Latinos, are likely to suffer from chronic conditions, because of their poor living standards. Chronic conditions typically do not have a cure, and the best that healthcare professionals do is to manage them so that patients live for longer periods. However, the cost of managing chronic conditions is always too high, and the insurance premiums for such diseases are always also too much for the low-income earners to afford. Therefore, the system is structured in a way that promotes inequality, subsequently exposing minority groups to various health risks, which deplete all their financial resources, leaving most people poor.
Phelan et al. (2010) posit that the unequal distribution of healthcare services in the United States is also affected by the providers’ opinions, stereotypes, and perceptions about the minority groups. Most of the minority groups do not have adequate healthcare professionals among themselves, especially because of the expensive education or training. Most minority groups cannot afford the expensive out-of-pocket tuition fees for the medical or health courses, and the only viable option usually is taking student loans. However, the thought of paying back the loans will most likely scare students from minority groups from taking expensive courses. On the other hand, majority White students can afford such courses. They come from relatively wealthy backgrounds and sometimes can afford the tuition fees without having to apply for the loans. Therefore, ultimately most healthcare professionals are Whites, and out of this group, there are some who hold various stereotypes or institutionalized beliefs about the minority groups. Definitely, with such beliefs, the healthcare providers can be biased, and therefore, will fail to address the healthcare needs of minority groups adequately.
One important theory that can explain the healthcare disparities between the various groups in the United States is the theory of fundamental causes. This theory states that socio-economic status comprises an array of resources such as knowledge, money, power, prestige, and beneficial social connections that cushion health regardless of what mechanisms are relevant at any given time (Phelan et al., 2010). In this case, the wealthy individuals in the United States will always benefit the most from whatever mechanism is put into place to ensure equality in the distribution of healthcare resources and services. With each system or intervention measure that is put into place, the wealthy, as well as the socially privileged groups, will always benefit the first and receive the best services because of their connections and power. In contrast, the minority groups will receive those services the last, and sometimes, in poor quality. Therefore, this theory explains why with the desire and push to equalize health delivery in the United States among all ethnic and social groups, significant disparities still seem to be existent.
Solution
Australia is one of the countries that provide the best healthcare services in the world, and the manner in which the system is designed promotes equality among the various groups. It is very rare to hear about criticism of the Australian healthcare system in relation to discrimination of various minority groups, and therefore, the United States can get important insights from this system. In the Australian healthcare system, all citizens, permanent residents, and specific visa holders are eligible for high-quality, free public inpatient and outpatient healthcare. The care comprises of free emergency department visits through Medicare. Although many people also incur an out-of-pocket cost to see a doctor in the community setting, the cost is usually affordable.
Australia also has a private cover for individuals who do not prefer the public cover. According to Dixit & Sambasivan (2018), about 57% of Australians choose to get private insurance cover. The private insurance cover can enhance allied health services, dental, and optometry. Secondly, the private cover also enhances access to private hospitals of an individual’s choice and reduction in waiting times for elective procedures. On the same note, the Australian government also gives a subsidy for private insurance costs to families. The Australian government funding of the public health cover is done through general taxation, and on top of that, all Australians pay a 2% Medicare income tax levy (Dixit&Sambasivan, 2018). Again, an additional tax levy of 1% is charged on high-income earners who opt not to take private cover.
According to Willis et al. (2016), another strategy that Australia uses to cap medical costs is that it has established a Pharmaceutical Benefits Scheme (PBS), which controls the out-of-pocket costs of various medications for all citizens. Therefore, the Australian government takes a central role in deciding how much the citizens pay for various medical services and drugs. As such, healthcare professionals and pharmacists do not have the freedom to decide their prices. Coupled with the regulation, the government also enforces these regulations and policies so that unscrupulous individuals face the consequences of breaching them. Ideally, the Australian government recognizes the importance of being in charge of the healthcare system, compared to the U.S government that seems to have left the healthcare system, as crucial as it is, to private players. The change of the U.S healthcare system is always a political issue, and with the intense lobbying from private players, major changes rarely see the light.
From the Australian healthcare system, the United States should nationalize its healthcare system because most of the countries, which have managed to reduce healthcare disparities among various social groups have universal healthcare (Percheski&Bzostek, 2013). Having a universal healthcare cover in the U.S means that basic and essential healthcare services will be funded through tax levies. To install such a system, there ought to be an enabling political environment or a willing government. A national healthcare system means that all people, regardless of their social backgrounds, will receive essential healthcare services. Secondly, it will be less expensive cumulatively to fund the healthcare system because the funding will be spread across all the citizens.
Secondly, it is also important for the government to regulate the out-of-pocket medication costs, because the lack of control makes healthcare professionals set their prices, which are usually too high. In addition, the government also needs to regulate the private health insurance sector, especially regarding how much they should charge for insurance premiums, and what type of cover they need to provide. Some insurance companies could charge high premiums but offer only limited cover. For instance, before the Affordable Care Act, many insurance companies did not provide cover for preexisting conditions, and that made many groups vulnerable. Since minority groups are likely to suffer more from chronic conditions, the insurance covers were almost useless, and even with the cover of preexisting conditions, some insurance companies are raising their premiums across the years (Archibald& Rankin, 2013). Some of these companies could likely exploit various groups because of the lack of regulation by the government. Therefore, to cushion various groups and achieve equality in the provision of healthcare services, the government needs to regulate the health insurance industry.
Conclusion
The American healthcare system raises social justice issues because of the different health outcomes among the various social, racial, and ethnic groups. From the literature, minority groups, in particular, Blacks and Latinos, receive poor health outcomes because of the issues dealing with the design of the system. For example, the healthcare system is very expensive, such that only wealthy individuals can afford quality healthcare. Most people from minority groups are low-income earners, primarily because of the history of the United States, where minority groups have been discriminated across the years. With the low income, clearly, it is difficult to afford the high insurance premiums charged by private insurance companies or the unregulated out-of-pocket payments. Some of the insurance companies are also selective in terms of the cover they provide, especially on chronic conditions, or choose to charge skyrocketing prices on such covers. Since minority groups are likely to suffer from chronic conditions because of the environment and their lifestyles, the system does not favor them. Hence, the disparities are likely to be evident across the years as the theory of fundamental causes suggests and predicts.
The solution to addressing the health disparities across the social groups in the United States lies in borrowing from the best practices of the Australian healthcare system. The United States government needs to have universal healthcare coverage funded by taxes. Secondly, the government needs to regulate the various stakeholders such as insurance companies, and healthcare organizations, especially in relation to what they ought to charge on the various medical services. Taking control of the healthcare system and initiating, as well as implementing the healthcare regulations, will promote equality in service access across all social groups. Lastly, and most importantly, the minority groups will be cushioned across crippling financially in the event of serious illnesses, especially chronic conditions. The savings can be used to improve the quality of their lives, and therefore, reduce the vast gaps between these groups.
References
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