HEALTH EQUITY AND HEALTH POLICY

“Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.” Access to health care is one of the many factors that affect health equity. In turn, there are many factors that affect access to health care including our Nation’s health policies.

Geography

Health equity is not possible if you don’t have access to health care. Per the U.S. Government Accountability Office (GAO), people living in rural areas have limited access to care due to hospital closures and workforce shortages.  They have farther to travel for care, often without reliable public transportation. In addition, telemedicine is of limited use due to lack of broadband internet services.

Insurance

It is difficult and expensive to obtain health care without insurance. On the other hand, health insurance is not an all-access pass to health care. Reimbursement rates vary among U.S. insurance companies. People insured by payors with low reimbursement rates (i.e. Medicaid), or high claim denials (i.e. Medicare Advantage) have a harder time finding providers who will accept their insurance.

Financial

Out-of-pocket costs which include deductibles and co-pays vary amongst insurers. Co-pays are due before the visit. They may range from $25 to $100 depending upon the type of service (i.e. primary care, specialist, emergency room).  For lab tests, procedures, and hospital stays, insurance covers at least 80-90 percent of the total cost and you may be responsible for the remainder.  These costs may be a barrier to seeking care for lower- and middle-class Americans. Avoiding care may lead to the need for emergency care or more extensive treatment due to a delay in diagnosis. Ultimately, many accumulate medical debt which they struggle to pay. This debt serves as an additional barrier to care as providers refuse further service until the bill has been paid.

Cultural Beliefs and Biases

Cultural beliefs and their influence on local and national policies create barriers to accessing health care and reduce the likelihood of attaining health equity. Negative biases affect people with:

• disabilities
• behavioral health and substance use conditions
• seniors
• women
• people who don’t identify as heterosexual
• immigrants
• the BIPOC (Black, Indigenous, and People of Color) community.

Biases intended or not affect availability and delivery of healthcare, both directly and through policy.

Health Policy

The recent wave of new policies in the U.S., in addition to old ones, take all but a few of Americans further away from health equity.

• The National Institutes of Health (NIH) funding provides support to research that provides needed care in the form of clinical trials to all Americans. This research is also responsible for development of treatments for numerous vaccines and chronic conditions.
• Subject matter experts in medicine, technology, and science have traditionally been the leaders of agencies that have been successful in developing and maintain a public health structure. Moving away from objective data to personal opinion puts us all at risk.
• The majority of Americans obtain health insurance through their employer.  Massive lay-offs and forced resignations will lead to loss of insurance.  Although the Affordable Care Act (aka Obamacare) provides a marketplace to purchase insurance, the cost is higher than the equivalent employer sponsored insurance. This price is well beyond the pocketbook of working Americans.
• Treating healthcare as a business and prioritizing profit over outcomes has led to lower quality of care, hospital closures, and lack of access to care. This was the point of discussion at last month’s Senate Budget Committee.
• Whether we like it or not, technology including air travel has created a connection between our nation and others. Stopping communication and cooperation between the CDC (Centers for Disease Control) and the World Health Organization (WHO) could leave us blind to the next Ebola or COVID infection that will cross our border through citizen travel as well as legal immigration.

Bottom Line

Health equity on the surface may appear to be an individual problem, but it isn’t. It isn’t simply about individual choices. Our ability to maximize our health depends on many factors including national health policy. If we didn’t know it before, certainly COVID taught us that.

References

Himmelstein DU, Lawless RM, Thorne D, Foohey P, Woolhandler S. Medical Bankruptcy: Still Common Despite the Affordable Care Act. Am J Public Health. 2019 Mar;109(3):431-433. doi: 10.2105/AJPH.2018.304901. PMID: 30726124; PMCID: PMC6366487.

CDC National Vital Statistics Reports, Vol. 69, No. 12. November 17, 2020