HEALTHCARE IN THE UNITED STATES

ACCESS ISSUES IN HEALTH CARE

Pause and Reflect

A non-native English speaker is about to be discharged from the hospital

following surgical removal of the appendix. The nurse comes into the room and

discusses the need for proper care of the surgical wound, to continue taking all

the antibiotic medications provided, and to call the primary doctor if there are

any complications (excess pain, fever, draining from surgical site). The nurse

asks if the patient understands the directions and they nod their head in the

affirmative. The patient is asked to sign the form, given the written discharge

instructions, and discharged to home. In this scenario, how do we know the

patient understood the instructions?

8.5.7 Health Disparities

Orgera and Artiga (2018) define health and healthcare disparities as “differences in health and healthcare between population groups” (para. 1). Various factors, such socioeconomic status, race, ethnicity, gender, sexual orientation, age, disability status, and regions of the nation, may affect the care individuals receive. We have already discussed reasons an individual may not seek healthcare and/or delay care and the costs associated with health insurance. Arguably, some variables consistently indicate there are some groups who receive less healthcare. The U.S. Office of Disease Prevention and Health Promotion (ODPHP, 2019a) states that those in a lower socioeconomic status receive less healthcare. And many persons in the poor and near-poor categories, according to the research presented here, delay healthcare or have difficulty with the costs of healthcare. One should note that many poor do receive Medicaid. However, as stated previously, Medicaid may not be accepted by all physicians.

Delving deeper into the unmet healthcare needs of persons based on poverty levels, the NCHS (2019) compared unmet (delayed or received) healthcare needs due to costs in persons based on national poverty levels from 2017 to results obtained in 2007 (based on data from the 2017 NHIS previously discussed). The poverty levels compared were the same as previously discussed elsewhere (below poverty level; nearly poor: 100–199% of poverty level) except two groups of not-poor were established: the first group of not-poor lived at 200–399% of the poverty level, and the next group of not-poor lived at or above 400% of the poverty level. Results indicated that although there has been improvement in meeting the medical needs in all groups since 2007, a divide remains between the percentage of unmet medical needs of the poor and those in the not-poor groups because of costs. Thus, those in the poor groups have unmet healthcare needs, and, as greater levels of poverty were identified, the discrepancy increased incrementally.

The NCHS (2019) also interviewed these same individuals in the 18–64 age group to determine if they received needed prescription medications. Again, despite the vast improvements in the last decade, there remains a difference in the poor, near-poor, and not-poor categories (Figure 8.5).

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