The purpose of this series of papers is to present a context of understanding of the prevailing health issues facing the African-American community. Hence forth and for brevity, the term “Blacks” and/or minority will be used interchangeably with Africa-Americans. Additionally the term “White” is or will be substituted for Caucasians or the majority.
The papers will have charts and diagrams which should be self explanatory and will assist the reader in viewing and better understanding the health disparity topic.
Going forward, one must maintain the following tenant to resolve the health disparity or any other equality gap, “The ability to address and solve an issue initiates with the desire and willingness to gain knowledge and understanding; to take the necessary action and the courage to stand firm and to take the required action to solve the issue at hand.”
There is an ongoing great debate regarding the access and availability of and to healthcare. The uniqueness of the debate regarding this topic is premised upon a simple but complex question, “Is healthcare a right or a privilege? Depending upon your economic philosophy, political orientation and social standing, the answer to the prevailing question will vary. Another dependent variable is the cultural identity factors along with your overall social orientation and personal value belief system.
The preamble to the United States Constitution has the words “…that all men and (women) are created equal.” Equality and parity are noble absolute panacea thoughts. With direct reference to healthcare access and/or delivery can simply is premised upon the ability to pay for black health the services one is seeking. For background and familiarity purposes here are some of the more common economic, revenue and related operational terms associated with healthcare. Terms ranging from but not limited to co-payment, deductible, reimbursement, indigent, self-pay, denial, pre-existing, etc.
Historically the majority of American citizens obtain healthcare services through their employer sponsored insurance package program offerings. These offerings vary from the so called ancient indemnity programs, health maintenance organizations (HMO’s) and now the latest and greatest package offering health savings accounts (HSA’s). We must not forget the federal governmental programs such as Title 19 and Title 20, Medicare and Medicaid respectively. In brief Medicare is the health insurance program for “senior citizens.” The Medicare offering has Parts A, B, and D. These benefit plans provide out-patient, in-patient and a prescription drug benefit. Medicaid on the other hand is a state run program with a significant financial subsidy coming from the federal government. Medicaid is often identified or recognized as the health benefit for the indigent and for children.
For our and future purposes and defined by the World Health Organization, Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. In a careful and quick review of the definition; everyone would desire a complete physical, mental and social well being. Since we reside in a highly structured or more so layered society, the different class, economic and social levels this “complete” social well being will be extremely difficult to attain.
Note chart (1) which presents the different spending levels within the US Healthcare system. The most significant portion of dollars spent for direct patient care are within the hospital arena totalling 30%. The next largest percentage is Other Spending at 25%. This basically represents diagnostic services such as a CT, MRI scans, etc. Only 21% is actually disbursed on Physician and clinical services.
With a focus upon the demographics, there is no direct data which presents these expenditures of Whites versus Blacks. One could assume based upon charts (2-3) that Whites do spend more on healthcare than Blacks solely predicated upon the life expectancy disparities between males and females from 2004.
Couple this data with the facts that the overall Black unemployment or underemployment rates are usually two and sometimes three times that of Whites. For a reflection, remember that the majority of American citizens gain access to healthcare through their employer sponsored health benefit offerings. Therefore if Blacks are more than or more greater than likely not to be employed, the Black health status, indices and life expectancy will be much lesser than their White counterparts.
Further and it is very common that Black often enter the healthcare system at a much latter time after the identification of diseases. In other words, Black often forego or do not have the economic means to access primary care physicians to establish what is called a medical home.
Primary care providers conduct routine or basic screenings such as blood pressure screenings, prostate exams, well woman exams, they order mammograms to rule out breast cancer. Through these limited examples, early detection of diseases often are not identified and treatment therefore cannot be initiated. Note chart (4) which depicts the matrix for the Continuum of Care.
For example a regimen of required medicines to correct hypertension or as it often labeled high blood pressure can begin. The identification of other cardio vascular issues can be detected, along with the detection of “sugar.” True, many Blacks do have the financial ability to access the system, but either through social orientation or lack of knowledge or a total ignorance the decision to utilize the healthcare system is ignored.
Series 2: Blacks and Medical Education