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Transcription
The healthcare system in the United States is complex and does not provide universal healthcare for free. Marginalized communities, such as people of color, face disparities in access to healthcare and insurance coverage. Asian Americans and Hispanic people are more likely to be uninsured compared to their white counterparts. There are contributing factors to this, including the types of jobs held and the affordability of health insurance. Mental health services are also less accessible to people of color. Disparities in healthcare also lead to differences in life expectancy based on race. In the South, where there is a higher percentage of people of color, there are higher rates of poor health status and uninsured individuals. Racial and ethnic minorities receive lower quality healthcare compared to white people, even when other factors are comparable. The COVID-19 pandemic has further highlighted the negative impact of the healthcare system on marginalized communities, particularly t Today, I will be discussing the healthcare system and how it is affecting marginalized communities in the United States. I will also be interviewing my mom, who is currently a social worker, seeing firsthand how people are negatively affected by the healthcare system. The term healthcare can be misunderstood at times and can vary by country. In the United States, universal healthcare is not provided for citizens for free. In the United States, a mixed system is used, combining privately funded plans along with public coverage from the government. These healthcare programs are commonly known as Medicare and Medicaid. According to an article published by ISPOR titled U.S. Healthcare System Overview, the United States has a population of over 330 million people and is supported by one of the most complex healthcare systems in the world, formed by intertwining relationships between providers, payers, and patients receiving care. The complexity makes it difficult for individuals to find affordable healthcare. Although the United States shares high healthcare causes among Yemen, South Africa, Iran, Pakistan, and a few more countries, they do not offer affordable healthcare to its citizens. About 73 countries offer free healthcare to the majority of its citizens. Brazil and Norway are unique cases because they are the only countries offering completely free healthcare to all of its citizens. Countries with the best healthcare in the world include France, Italy, Norway, Austria, Singapore, and more. Norway is one of the healthiest countries in the world due to its healthcare system and its affordability and access to all. You may be wondering, what does healthy look like and how does Norway define health? If you were to measure health statistically, you would look at the country's gross domestic product, the GDP. More observable ways to define health would be a country's access to clean water, nutrition, a high life expectancy, health risks citizens are facing, and the medical statuses of individuals. Now I will further discuss how race affects the access to health insurance and the statistics of people of color compared to white people. According to an article titled Key Data on Health and Healthcare by Race and Ethnicity published by KFF in 2023, Asian American, 21%, and Hispanic people, 19%, were more than twice as likely as their white counterparts to be uninsured in 2021. To me, this was a very alarming statistic to hear of comparing the Asian Americans and Hispanic people to compare to their white, to the white counterparts. And majority of these Asian American and Hispanic people are uninsured because they don't have access to these resources. There are many contributing factors to the amount of people of color being uninsured in America, one including the types of jobs they hold that do not provide health care services. This also stems to the access to education that these people of color have in America in order to get these high paying jobs that have all the benefits that provide them with that health care service. Another is affordability of health insurance. In America, health insurance is at a very steep price and it's hard for just, it's hard for people to afford it. When looking at statistics on the KFF website, I came across one that really startled me. In the United States, only 25% of Asian people, 36% of Hispanics and 39% of health care, 39% of black people receive mental health services. This is compared to the 52% of white people in America who do. This was personally really frightening to me because I'm such a big advocate for mental health. In my future career, I aspire to be a social worker providing mental health services to all, regardless of how they identify or the color of their skin and it's really important for me to give people a safe outlet and to express their concerns. Having a stable mental health is crucial to being a high functioning person in society and being the best version of oneself. It really makes me sad that due to the color of someone's skin that they might not have access to these mental health resources like the white Americans do. And I think actions need to be made to provide these mental health services to everybody. And sometimes it's harder for certain races to reach out because of their family dynamic or the environment they're growing up in. In 2021, white people's life expectancy averaged 76.4 years of age in the United States compared to black and Asian life expectancy of 65.2 and 70.8. That is almost a 10 to 5 year difference in life expectancy just based off of their race. Reasons for this include inadequate health treatment. In the south of the United States, it is found to be more racially diverse. One in five Americans, which is 20% at adult age, report to be in poor health status. The northeast reports 17% and the midwest reports 16%. Demographically in the south, there's a lot more people of color. That's why it is seen to have a higher percent of poor health status. Additionally, in the south, obesity and diabetes rates are found to be a lot higher. In the state of Iowa, 9% of the population reports to have diabetes compared to a southern state of Georgia who reports 14% of the state to be diagnosed with diabetes. Other limiting factors to this might be the ruralness of the state and access to fresh grocery stores who have healthy and organic foods. Or if there is a local healthy food store, they're often to be overpriced and made unaffordable. And people in these rural areas, they have a hard time getting there because of transportation at times. Well, in the south, there's a higher chance that individuals are uninsured. That's why they have a higher – they have a higher poor health status. According to an article published by KFF in 2016 titled Health and Health Coverage in the South, among the total non-elderly population, 15% of individuals in the south are uninsured compared to 10% of individuals living in the rest of the country. Others contributing to the statistic may include the fact that Medicaid eligibility levels are increasingly more higher in the southern states and harder to access. Hearing this is very concerning and makes me wonder what can healthcare providers do in order to make a change and to make it more eligible – people more eligible for insurance such as Medicaid. As I was researching how people of color face disparities in the United States, I came across an interesting article published by American Bar titled Implicit Bias and Racial Disparities in Healthcare, and I came across a shocking piece of information. Racial and ethnic minorities receive lower quality healthcare than white people, even when insurance status, income, age, and severity of condition are comparable. By lower quality healthcare, this means – this is because of systematic factors that are out of the color people's control. They're facing constant discrimination and disparity in the United States. Healthcare officials treat colored people – individuals differently than they would than with a white person. Unequal treatment in healthcare can look like a refusal of treatment, lack of attention to detail, not taking a colored person's illness seriously, or not providing attentive treatment. Growing up with a mom as a social worker has allowed me to hear stories firsthand how people have been negatively affected by the healthcare system because of their race. My admiration for my mom's work has guided me in choosing my future career as a social worker. I will be welcoming Darla Mascolo, who is a licensed clinical social worker currently at Highland Park Hospital. She has been a social worker for over 30 years and has experience in many different settings, including Rush University Hospital in Chicago, where she dedicated over 25 years of working there. Through her time as a social worker, she has encountered many different people in many different situations. She will now share some stories that took place during the COVID-19 pandemic that demonstrate how the minority groups have been negatively impacted by the healthcare system. Hi, I'm happy to be here today to share my experience working as a social worker during the pandemic. I've worked in healthcare for about 30 years, often serving minority and underserved communities, and I really noticed during the pandemic that, you know, people of color and marginalized individuals are really affected, especially the Hispanic population. I started noticing we were getting more and more patients being admitted who were of Hispanic descent, and I think one of the reasons that we had such a high percentage of patients who were Hispanic is just because of the working, you know, the low-paying service jobs. They were forced to work. They didn't really have an option, so they were going to work, being exposed to COVID, then coming home. Oftentimes, there were multiple people living in the same home. Patients couldn't self-isolate. They couldn't socially distance, and it just really became apparent in the Hispanic population that it was really affecting them disproportionately. Additionally, a lot of Hispanic patients are – do not have – their legal documents are undocumented, and they don't really have access to services such as someone that has insurance would have. We often had to rely on the government during the pandemic. The government was offering free oxygen for patients. We were also doing a lot of free services, and so the Hispanics were not getting the rehab that they needed post-acute COVID. Thank you for sharing that really good insight on what the healthcare system was like for some minority groups during the pandemic. So in what ways can we see the differences in treatment and post-hospitalization based on one's insurance coverage? I think the biggest difference is a lot of Hispanic patients are undocumented, and when you're undocumented, you don't qualify for any kind of state-funded healthcare. You get emergency services, which means your hospitalization will be paid for, but there's no – there's no coverage for follow-up services like medication, home healthcare. If you need rehab, there's just no funding. So that has really impacted the Hispanic population. So one of the other things that really affected patients during the pandemic is those who had government-funded services, such as Medicaid, especially in Illinois. A lot of the Medicaid plans have switched over into a managed care, and a lot of providers don't accept that type of insurance. So even if a patient was admitted and had, for instance, Medicaid, which you'd think they would have coverage, going to get services for that patient was very difficult. Services are being denied. There's a lot of providers that aren't in network, so a lot of those patients weren't able to get adequate support. So it wasn't just uninsured patients. It was also patients who are what I would consider to be underinsured or rely on government-funded programs. And those are a lot of minority populations, also patients with disabilities, patients who have mental illness, the ones who are really most vulnerable. So in the early stages of the pandemic, there wasn't the treatment that eventually evolved with the treatment of COVID. So a lot of patients were coming in the hospital. They were having really long stays in the ICU, sometimes like three or four weeks. And then they would need a rehab service after leaving. They might not be able to walk. Their respiratory status was very compromised. In particular, I had a gentleman. He was a 43-year-old African-American who is admitted. He worked in a service job, contracted COVID, had a lot of comorbidities. I believe he had COPD, diabetes, and a lot of other medical factors. So when he got COVID, it really impacted him. He ended up staying in the ICU for about three and a half weeks, and he had, it was a Meridian Medicaid plan. So he basically needed some rehab when he transitioned out of the ICU. Going to get rehab, his insurance denied it. So what happened? He ended up going home without the services that he needed, and ended up being hospitalized within three days of his discharge. Again, thank you so much for coming in and sharing insight about how you see firsthand how the healthcare system is really, it's hard for certain minority groups to access. I think seeing this perspective from a social worker who's in healthcare, who's in the hospital, is really important for individuals to be able to grasp the disparities that are really in healthcare. After this podcast today, I hope you learned a little bit more about the healthcare in the United States, and how we have a very different system from other countries, and how there's a lot of improvements to be made.
