In its current state, the US is the only country to lack a uniform health system and without universal coverage amongst the industrialized countries. Over the years, different administrations have made attempts to create national health coverage aimed at bridging the social inequality gap and improving access. However, changes made have largely been incremental. The US health care system ranks last amongst other 11 industrialized nations in terms of access, efficiency, and equity.
Inequalities continue to persist as a result of prohibitive high costs that have widened the socio-economic gap. Racial and ethnic differences also partly contribute inequalities within the health care system for instance; Blacks and Hispanics are more likely to receive non-optimal organizations in comparison to whites. Income-based health disparity in the US is equally among the highest in the world according to a report by Health affairs (2017). These inequalities continue to persist as a result of private interests, partisan politics, fear and apathy.
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The average mortality rate in the US currently stands at 8.782 deaths per 1000 live births. Relative to comparable countries, the US has 63% more neonatal deaths. Disease incidence and disease prevalence in the US are higher in the age groups 55-64 and 70-80. Infection rates respiratory infections and sexually transmitted diseases have dropped 19% since 1990 to date.
As of 2019, at least 27.5 million Americans lacked health insurance. This is representative of 8.5% of the total US population. A significant drop in the number of uninsured has been witnessed since the enactment of the Affordable Care Act. In 2010, 49.9 million people in the US lacked health insurance. Over reliance on private insurance and the absence of a universal coverage plan are the key contributors to the high number of uninsured Americans. To be eligible for health insurance, one must be living in the US, be there legally, and not be incarcerated.
Addressing the inequalities within the health system will require the implementation of several policy changes. Embrace broad and inclusive research themes that incorporate multilevel factors such as; social and economic policy, work environments, and community characteristics among others. In country where the greatest barrier to access to health care is cost, implementing universal health coverage would greatly reduce the social economic disparity. Developing platforms for innovative trasdisciplinary research with the goal of promoting systems science approaches is likely to result in better health care at lower costs. Engaging patients, communities, health providers, and policy makers in the research agenda to the identification, dissemination, and implementation of effective policies is a key step in reducing health inequalities.
Among OECD countries, 32 of the 35 member countries have implemented universal health coverage to mitigate income-related inequalities in access. This is a pointer to just how essential universal health coverage is. Other countries have enhanced collaboration between the public and private for the purpose expanding access, sharing of medical knowhow, and improving the quality of care by levering capital and managerial capacity. Additionally, many developed nations have put significant amounts of resources towards preventing their people from getting sick.
Social institutions connected to health care inequality include family, race, government, and the economy. The health of an individual has an impact on the whole family. Equally, family dynamics have both positive and negative impacts to varying degrees. Consequently, well-being is enduring and consequential for the emotional and psychological well-being of the whole family. Social relationships, such as those found in close families, have been found to be negatively affected by the prevalence of chronic diseases, mental health, and disability, among other illnesses. In cases of segregated neighborhoods, race as a social institution has a considerable impact on health. Race and ethnicity are essential mechanisms through which neighborhood segregation impacts self-rated health. The government is the key player within the health care system. Government policies either have a positive or negative impact. In addition to policies, health care takes up a large percentage of any country’s budget. Resources availed by the government will either entrench or reduce inequalities. The economy suffers when the populace cannot engage in productive activities as a result of poor health.
Access to health care and the quality of care is tied to one’s financial status. Generally in all economies, wealthy people have far much easy access to quality health care around the world in comparison to low income earners. Specialized treatment is often expensive and not available at every health care facility. The poor are likely to lack access to specialized health care for the reasons that they either cannot afford it and/or have no access to specialized facilities. Such is the importance of one’s status in determining access and quality of care.
All social groups are connected to health care inequality. Equally, all social groups need good health. Depending on one’s family, race, governmental administration, and economic status which they fall under, health inequalities are either reinforced or diminished. For example, by virtue of living in a country with universal health coverage, health inequalities are significantly reduced regardless of one’s family, race, or economic ability.
The manners in which people interact, relate, or treat one another on the basis of their racial or ethnic background will reflect in the kind of health care service people belonging to these groups will receive. Where neighborhood segregation is entrenched, the same people are likely to face increased health inequalities.
Understanding how structure and agency are affecting and contributing to health inequality offers a better understanding of the necessary changes needed to realize equality in health care. The key to overcoming the inequalities is implementing universal health coverage.
