Health Care In America Separate And Unequal

The American health care system is a unique mix of public and private programs that critics argue has produced a two-tier system - one for the rich and the other for the poor - that delivers dramatically unequal care and leaves millions of Americans seriously underinsured or with no coverage at all. This book examines the root causes of the inequalities of the American health care system and discusses various policy alternatives. It systematically documents the demands on and the performance of our health care system for different population groups as defined on the basis of gender (women), age (children), race and ethnicity (African Americans, Hispanics, Native Americans), and residence in high poverty areas (rural and inner city locales).For each population, the book documents: historical and demographic profile, data on health status, aspects of inequality including access; quality of care; and endemic, cultural, and lifestyle issues affecting health; policies, laws, and programs relevant to health care; and, indicators of improvement or negative trends.

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

As the population of older Americans grows, it is becoming more racially and ethnically diverse. Differences in health by racial and ethnic status could be increasingly consequential for health policy and programs. Such differences are not simply a matter of education or ability to pay for health care. For instance, Asian Americans and Hispanics appear to be in better health, on a number of indicators, than White Americans, despite, on average, lower socioeconomic status. The reasons are complex, including possible roles for such factors as selective migration, risk behaviors, exposure to various stressors, patient attitudes, and geographic variation in health care. This volume, produced by a multidisciplinary panel, considers such possible explanations for racial and ethnic health differentials within an integrated framework. It provides a concise summary of available research and lays out a research agenda to address the many uncertainties in current knowledge. It recommends, for instance, looking at health differentials across the life course and deciphering the links between factors presumably producing differentials and biopsychosocial mechanisms that lead to impaired health.

"The Affordable Care Act set off an unprecedented wave of health insurance enrollment as the most sweeping overhaul of the U.S. health insurance system since 1965. In the years since its enactment, some 20 million uninsured Americans gained access to coverage. And yet, the law remained unpopular and politically vulnerable. While the ACA extended social protections to some groups, its implementation was troubled and the act itself created new forms of exclusion. Access to affordable coverage options were highly segmented by state of residence, income, and citizenship status. Unequal Coverage documents the everyday experiences of individuals and families across the U.S. as they attempted to access coverage and care in the five years following the passage of the ACA. It argues that while the Affordable Care Act succeeded in expanding access to care, it did so unevenly, ultimately also generating inequality and stratification. The volume investigates the outcomes of the ACA in communities throughout the country and provides up-close, intimate portraits of individuals and groups trying to access and provide health care for both the newly insured and those who remain uncovered. The contributors use the ACA as a lens to examine more broadly how social welfare policies in a multiracial and multiethnic democracy purport to be inclusive while simultaneously embracing certain kinds of exclusions"--Publisher's website.

Fully updated, this new edition provides a comprehensive examination of the ways that health policy has been shaped by the political, socioeconomic, and ideological environment of the United States. The roles played by public and private, institutional and individual actors in designing the healthcare system are identified at all levels.

Fully updated in this new edition, Health Care Politics and Policy in America combines a historical overview of U.S. health policy and programs with analysis of current trends and reform efforts. The book -- shows how health policy fits into the larger social, economic, political, and ideological environment of the United States; -- identifies the roles played by both public and private, institutional and individual actors in shaping the health care system at all levels; -- considers the trade-offs inherent in various policy choices and their impacts on different social groups; -- takes account of the dynamic impact of technological change on health care capacities, costs, and ethics. This edition includes expanded discussion of equity issues and whether there is a "right" to health care, and a new chapter on the issue of medical liability. The concluding chapter brings the story of health care policy up to the end of the millennium, with particular attention to the managed care revolution and reaction to it. The book equips readers with the basic tools for drawing more informed judgments in the ongoing debate about health care policy in the United States.

This book provides a comprehensive examination of the ways that health policy has been shaped by the political, socioeconomic, and ideological environment of the United States. The roles played by public and private, institutional and individual actors in designing the healthcare system are identified at all levels. The book addresses the key problems of healthcare cost, access, and quality through analyses of Medicare, Medicaid, the Veterans Health Administration, and other programs, and the ethical and cost implications of advances in healthcare technology. This fully updated fourth edition gives expanded attention to the fiscal and financial impact of high healthcare costs and the struggle for healthcare reform, culminating in the passage of the Affordable Care Act, with preliminary discussion of implementation issues associated with the Affordable Care Act as well as attempts to defund and repeal it. Each chapter concludes with discussion questions and a comprehensive reference list. Helpful appendices provide a guide to websites and a chronology. PowerPoint slides and other instructional materials are available to instructors who adopt the book.