Determinant of Health: Access to Quality Health Care

Question 1

List at least 3 ways in which healthcare in the US is different from other developed countries

Answer 1

The US is the highest spenders on health but the infant mortality rate is comparable or even worse than many developing nation.
The US has the highest rates of income inequality which leads to lack of access and lack of affordability of healthcare for a significant number of people in the US society.

Insurance is not universal.
Employers do not have to provide coverage
Majority of the coverage is provided by the employers.
However it is optional and many do not.
Individuals do not have to buy coverage but that changed in 2014.

Question 2

What is health disparity and health inequity

Answer 2

Health disparity is the differences in health in different groups of people for example male babies are born at a heavier weight than female babies. However Health inequity are differences in health outcome between groups of people that are preventable and unfair for example babies born to black women are more susceptible to die as infants that babies born to white women.

BUT health equity is not just the lack of health inequities or the opposite of healthy inequity
Not all health disparities are health inequities, however, all health inequities are also health disparities

Question 3

What determines access to quality healthcare

Answer 3

1. Lack of primary care physicians
2. Financial reasons - lack of insurace, high co pay, high cost of insurance
3. Geographical reasons
4. Cultural
5. Language/health literacy

Question 4

What is structural violence

Answer 4

Think broadly beyond lack of health insurance—think about inability to pay for co-pays
Structural violence is a newer concept that refers to “the social inequalities that range from racial bias to overt violence that are embedded in political and economic organizations that cause injury to people

Question 5

Comments on the pie chart he showed us about the proportions of different type of people that are uninsured

Answer 5

Largest predictor for being uninsured is being a child in a working poor family—employed adults make work in companies with

Question 6

Obamacare and define the gap

Answer 6

Each state had to create an insurance exchange for individuals without coverage and also for small employer that did not offer health coverage.
The other part of Obamacare was the expansion of Medicaid.
It is important to know that what kind of people fell into the gap that was created with the introduction of Obamacare. When Obamacare was introduced it was determined that people within 100% to 400% of the poverty level will be given subsidies to buy healthcare insurance on marketplace. However people with less than 100% of poverty level were supposed to be covered by Medicaid. However this Medicaid program was challenged in the court and then it was decided that the states can either opt in or opt out of this program. Those states that decided to opt out of the program created this gap in individuals who were below the 100% poverty level and they were still not responsible for buying health insurance on marketplace.

So basically the people in the gap are those who would have qualified for Medicaid if their state representatives had decided that they will opt in. These people cannot purchase insurance on the Exchange either.

Question 7

Who didn’t get covered by Obamacare

Answer 7

It is also important to know that after adding another 32 million people to the health coverage about 23 million people were left without coverage. We need to know who these people were:

1. Undocumented workers (about 7 to 8 million people)
2. People eligible for Medicaid but didn’t enroll
3. People who decided to pay the penalty tax instead of buying the health insurance
4. Those who didn’t purchase the coverage but are exempt from penalty tax since they have low income.

Question 8

What is the social gradient

Answer 8

“Social gradient,” in which the more income and wealth people have, the more likely they are to live longer, while people with less income and wealth can expect to live comparatively shorter lives.
The influence on health is more than just rich vs. poor. People who live in “middle class” areas can expect to live longer than those in poor areas, but not as long as those in more affluent neighborhoods.