Betancourt, J.R., Green, A.R., Carrillo, J.E., & Ananeh-Firempong, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports 118: 293.
Betancourt et al. (2003) chose to study the effects of certain interventions in health care to dispel racial and ethnic disparities that are accepted to occur within the healthcare system. The objective is to ultimately find a framework that equalizes and eliminates these disparities; the researchers hypothesize that a framework of their devising could address these disparities and implement equitable health care regardless of ethnicity or race. A literature review was conducted in order to determine sociocultural barriers experienced in seeking care, as well as where these barriers occur and proper cultural competence efforts toward that end.
The researchers found that there were many sociocultural barriers that exist throughout many levels of health care - in organizational, structural and clinical levels. To that end, cultural competence interventions that have occurred include minority recruitment, interpreter services, provider education on issues related to other cultures - all of these efforts were thought to have immensely positive results on addressing the aforementioned disparities. The researchers conclude that, having structured these interventions into a practical framework, proper application would yield eliminating the disparities present and offer more equitable care to all American citizens.
Fiscella, K., & Holt, K. (2007). Impact of primary care patient visits on racial and ethnic disparities in preventive care in the United States. Journal of American Board of Family Medicine 20(6): 587-597.
Fiscella & Holt (2007) perform a study in order to determine what the causes of racial and ethnic disparities in preventive care in the United States might be. According to their hypothesis, minority patients help to create the disparity by visiting primary care facilities less often, and therefore creating fewer opportunities for care. This study was conducted on interviews and hospital records for several older Medicare beneficiaries, examining five different preventive services, including colorectal cancer testing, pap smear and lipid screening, mammography and flu vaccines. The effect of minority status on these preventive services was examined, taking into account number of primary care visits.
The researchers found that minorities, on the whole, had fewer claims for all of the preventive care procedures than non-minorities. Taking out all socioeconomic factors, race was only a factor in diminishing the rates of colorectal cancer screenings and flu vaccines. In conclusion, the researchers found that socioeconomic disparities were primary reasons for a lack of primary care visits by minorities, which contributed to a lower level of comprehensive health care when it came to preventive services.
Kim, J., & Richardson V. (2012). The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States. Health & Social Care in the Community 20(1): 42-51.
Kin & Richardson (2012), in their study, examine the impact of socioeconomic inequalities and a lack of health insurance on the health of individuals in the United States. The objective is to determine whether or not this lack of health insurance accounts for health disparities present among the growth functioning of individuals, hypothesizing that it does play a factor. A study of over 6500 adults of mixed race and socioeconomic background was performed, analyzing information regarding their health insurance and their financial and physical wellbeing. The change in physical conditioning over time was performed through latent growth curve modeling.
According to the results, individuals who had private health insurance experienced a slower decline in physical functioning. When individuals experienced setbacks in economic stability, like losing assets or income, their physical functioning diminished (in women moreso than men). Blacks and whites were not seen as having different declines in health after accounting for financial status. The researchers then conclude that socioeconomic stability and status does play a significant role in the health of individuals, and that balancing these inequalities could help in creating a cumulative net gain in physical functioning.
Lave, J.R., Keane, C.R., Lin, C.J., Ricci, E.M. et al. (1998). The impact of lack of health insurance on children. Journal of Health & Social Policy 10(2): 57-73.
Lave et al. (1998) seek to learn the specific detriments or effects on children that come from a lack of health insurance. The researchers hypothesize that not having health insurance has a cumulative net loss in the quality of life of a child. To that end, a study was conducted of families of children who recently entered a health insurance program specific to children. Telephone interviews were conducted in which questions were asked regarding the child's health, the quality of care of the services provided, what happened when care was delayed, and so on. Qualitative and quantitative methods were used to analyze the data taken from the interviews.
According to the results, children who were uninsured were met with needs that were not seen to, and care for illnesses and conditions was delayed. The more time the child was without insurance, the longer the delay. A lack of health insurance also led to a distinct limitation in the children's participation in activities, in order to prevent the risk of needing health care or treatment. The researchers conclude that the net loss in health care and quality of life for children in America experienced due to a lack of health insurance cannot be ignored.
Williams, D.R. & Rucker, T.D. (2000). Understanding and addressing racial disparities in health care. Health Care Financing Review 21(4): 75.
Williams & Rucker (2000) seek to determine exactly what racial disparities exist in the American health care system, if at all. The hypothesis tested relates to whether or not there is an institutionalized racism or discrimination present in the health care system, and which factors contribute to it (and may help to address it). A literature review is conducted in which varying studies, pieces of legislature and other literature on the subject of societal discrimination are studied in the context of health care.
The researchers found that there is a great deal of institutionalized discrimination that takes place against ethnic and racial minorities on an individual and organizational level. Many of these behaviors are unintentional or not overtly realized, but they exist, and they contribute to a net loss in equitable health care for minorities. Policy and research directions suggested in the literature review include addressing inequalities by improving equity in access to medical care, monitoring the quality of provided medical care, renewing vigilance in setting regulations to provide equal treatment, and so on .
Summary:
In each of the findings present, a distinct connection was made between socioeconomic status, the presence of health insurance, and the level of health care received by individuals. A lack of health insurance is directly tied to delays in care, particularly among children, which can lead to more health problems down the road. Physical conditioning and functioning deteriorates rapidly and consistently when people are uninsured; as they do not want to cover the exorbitant costs on their own, they simply ignore the problem. This leads to an overall increase in spending when a condition eventually occurs.
Many racial and ethnic disparities were found as well. In the studies examining these disparities, minorities received lesser care typically due to socioeconomic factors, institutionalized discrimination often leading to lower incomes, and consequently worse health insurance, for many of these individuals. This leads to fewer primary care visits, fewer screenings for conditions such as breast cancer, and an overall lower quality of life. Uninsured minorities typically end up incurring a greater proportion of costs relative to their income as well, creating further economic issues for the uninsured in the long run regardless of race.
Given the issues present when one does not have health insurance, the need for health insurance becomes abundantly clear. With the presence of adequate health insurance, patients are less reticent to seek primary and preventive care, which can then lead to a greater quality of life and fewer costs incurred through preventive care as opposed to addressing known preventable conditions.
References
Betancourt, J.R., Green, A.R., Carrillo, J.E., & Ananeh-Firempong, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports 118: 293.
Fiscella, K., & Holt, K. (2007). Impact of primary care patient visits on racial and ethnic disparities in preventive care in the United States. Journal of American Board of Family Medicine 20(6): 587-597.
Kim, J., & Richardson V. (2012). The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States. Health & Social Care in the Community 20(1): 42-51.
Lave, J.R., Keane, C.R., Lin, C.J., Ricci, E.M. et al. (1998). The impact of lack of health insurance on children. Journal of Health & Social Policy 10(2): 57-73.
Williams, D.R. & Rucker, T.D. (2000). Understanding and addressing racial disparities in health care. Health Care Financing Review 21(4): 75.
