For a world superpower and an industrialized nation, the US has a severely disjointed, unequal system of health care that favors the wealthy. The US spends more than 15% of its GDP on health care[i], yielding advanced medical equipment, high-tech facilities, modern medical research and— paradoxically—a low life expectancy as compared to other developed nations and disproportionally high rate of uninsured citizens. Despite the high spending, currently 42% of US adults are uninsured or underinsured.[ii] America’s health care system is indeed the country’s kryptonite, causing a breakdown and inability to meet the needs of the American people
“Inequities in health systems further exacerbate social and political inequities as the poorest and most vulnerable populations have higher absolute and disease specific rates of morbidity and mortality than the most privileged, yet less access to health care.” [iii]
There is tremendous inequality in ability to access health care in the US. The small percentage of citizens who can afford health insurance and medical care are separated from the underinsured by a great divide. As the only industrialized nation without universal health coverage[iv], the US has created a grave disparity between the wealthy—who can not only afford health care, but have choices of physicians and options of advanced treatment—and the poor who have limited choices or no care at all within their means.
Due to these disparities in availability of care and quality of services, there are significant differences in how the health care system is utilized across varying socioeconomic statuses. Studies have shown that individuals with low socioeconomic status utilize—and prefer—more hospital based services as opposed to primary care[v]. Qualitative data show trends in preference due to a perceived notion that hospital care is more accessible, affordable, and of higher quality[vi]. Of course we know this not to be true, as it is recognized that 38 billion is spent each year due to over utilization of US emergency departments[vii]. Statistics show that individuals of low socioeconomic status utilize 45 % less ambulatory care as compared to high-SES patients[viii] which has great implications on healthcare spending and on overall health of this population.
For a world superpower, America’s system of health care is wrought with flaws in accessibility, spending and coverage. In order to maintain our “superpower” status, great strides need to be made in improving our health system and reducing health disparities.
[i] Anne-Emanuelle Birn, Yogan Pillay, Timothy Holtz, Textbook of International Health: Global Health in a Dynamic World (Oxford: Oxford University Press, 2009), 605.
[iii] Ibid., 619.
[iv] Ibid, 605.
[v] Kngovi, S., Barg, F., Carter, T., Long, J., Shannon, R. & Grande, D. “Understanding Why Patients Of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care”(2013) Health Affairs. 32:7, 1196-1203.
[vii] New England Healthcare Institute. “A Matter of Urgency: Reducing Emergency Department Overuse.” A NEHI Research Brief-March 2010
[viii]Kngovi, S., Barg, F., Carter, T., Long, J., Shannon, R. & Grande, D. “Understanding Why Patients Of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care” (2013) Health Affairs. 32; 7, 1196-1203.
(cartoon by Robert Leighton)