Literature Review on Access to Healthcare among African Americans

What Has Been Published

There are questions and debates in the U.S. surrounding access to health care by the ethnic minority, especially African Americans. Although there is a claim that the U.S. has the best healthcare system in the world, the truth is that the country lags behind in many important health measures because citizens of certain races experience poorer healthcare services as compared to others. A 2014 report by the Robert Wood Johnson Foundation indicates that race and ethnicity continue to influence the chances of a patient receiving specific healthcare interventions and treatment. In particular, the high cost of healthcare has been found to be the leading in lack of access to healthcare services among African-Americans and the efforts to bridge this gap have never borne any meaningful outcome.

Theoretical Framework within Which the Problem Exists

According to the report by the Robert Woods Johnson Foundation, African-Americans experience between 30 to 40 percent poorer health outcomes compared to their White counterparts. This disparity is attributed to the high cost of health care and low-income status of African Americans. In recent decades, a significant growth in income inequality has been witnessed with this perpetuating health disparities in the U.S. This comes amidst the theorization that income is strongly correlated with an increase in mortality and morbidity rates across the income distribution. The review by the NORC (2018) indicates that 40 percent of African-Americans say they skipped recommended medical test or recommended treatment in the last one year due to the high cost of medication and access to healthcare services in general. Many African Americans, especially those from low-income households, report having a fear associated with the cost of illness than the illness itself.

Literature Review

Several studies have been conducted to investigate the relationship between the cost of health care and quality of life among African Americans. The result indicates that African American depicts an ethnic group with low income. Studies have also suggested that poverty is one of the social determinants of health. Poverty results in lack of access to healthcare services for African Americans. Noonan, Velasco-Mondragon, & Wagner (2016), using a modified social ecological model, conducted a review of literature on African American health. While discussing the health disparity in the U.S., they found that poverty is one of the social determinants that affect access to healthcare among African Americans. In this study, Noonan, Velasco-Mondragon, &Wagner (2016) found that 30 percent of African Americans are affected by the high cost of health care and believe that their health depends on fate or destiny. The researchers contend that is one of the leading predictors for the inadequacy of basic human needs such as the access to healthcare. African Americans remain the poorest ethnic group in the U.S. and with a high cost of health care services, the majority are not able to fund their healthcare.  There is a strong correlation between poverty and poor health outcomes as well as the increase in mortality and morbidity rates.  Noonan, Velasco-Mondragon, &Wagner (2016) also mentioned that transportation is a common problem with poor communities and this is one of the contributors to a lack of access to healthcare among African Americans. In the same study, Noonan and his colleagues tried to explore the measures that have been put in place to ensure that there is no ethnic disparity in access to healthcare services. As outlined by Noonan, Velasco-Mondragon, &Wagner (2016), in 2003, the Institute of Medicines released a guideline that aimed at reducing disparity in access to healthcare dubbed “Equal treatment: Confronting Racial and Ethnic Disparities in Care.” This was a good initiative but it never came to pass because it did not address the core reason for lack of access to health care among African Americans, which is poverty.

There is a disparity in health insurance coverage between racial and ethnic groups in the U.S. A study by Sohn (2017) revealed that African Americans had persistently lower insurance coverage rates at all ages and this significantly affects their ability to access healthcare services. The cost of healthcare in the U.S. is very high and those who are insured are the ones who are at a position to get access to costly healthcare services. African Americans being the poorest ethnic group in the U.S. cannot afford the high cost of health care services. The researcher used a longitudinal study with 114,345 participants to describe the disparity pattern and the cause of disparity prior to the Affordable Care Act. In this study, Sohn (2017) first acknowledges that the cost of healthcare in the U.S. is the determinant of a lack of access to care among African Americans. The researcher found that African Americans, due to their socioeconomic status, are associated with greater insurance loss and slower insurance gain, and this makes them disadvantaged in regard to access to healthcare services. Sohn (207) found that there is a high unemployment rate among African Americans and job loss is prevalent among them. This makes them be incapable of meeting the high cost of healthcare services.

In another study conducted by Riley, Hayes, &Ryan (2016), the U.S. healthcare system does not perform well for African Americans. According to the study, African Americans on average experience worse access to care due to their low socioeconomic status and high cost of healthcare services. Inequity in preventable deaths is common, and this is attributed to the disparity when it comes to accessing affordable health care. Riley, Hayes, & Ryan (2016) argue that a good number of blacks in the U.S. have no health insurance covers resulting in the challenges they face in the access to healthcare services. The high cost of healthcare services is attributed to high mortality and morbidity among African Americans. The study in its further analysis of the effect of the high cost of healthcare among African Americans found that 1 out of 5 African American adults cannot see a healthcare provider at the time of need due to cost constraint compared to 1 in 9 Whites. The introduction of the Affordable Care Act was seen as the potential to reduce health disparities and enhance access to health care among African Americans but there is still deepening inequities for the most vulnerable Americans especially African Americans.

Duckett & Artiga (2013) conducted a study to investigate health coverage for the Black population under the Affordable Care Act. The researcher conducted a review of the literature on the employment status of African Americans and how it relates to their access to health care. Duckett & Artiga (2013) found that 70 percent of African Americans are employed in blue-collar jobs, which earn them little income. Such blue-collar jobs are less likely to offer them health insurance coverage to cater for access to the rising cost of healthcare services. Duckett & Artiga (2013) found that African Americans are more than two times more likely to have a family income below the poverty level compared to the Whites. The introduction of the Affordable Care Act was seen as an effort to bridge the disparity in access to healthcare by African Americans but it has not done well.

McMorrow, Long, Kenney, & Anderson (2015) conducted a study to investigate the effect of the Affordable Care Act on access to healthcare services among African Americans. McMorrow and his colleagues acknowledge that there is racial disparity in access to health care services in the U.S. and this disparity is attributed to the high cost of care. The intent of the Affordable Care Act was to increase accessibility and affordability of health insurance and it was expected to eliminate some of the persistent disparities in access to health care services. According to McMorrow, Long, Kenney, & Anderson (2015), Affordable Care Act has significantly increased the number of African Americans who have health coverage. However, many African Americans still cannot access health care services due to the cost constraint attributed to their socioeconomic status.

From the above literature review, it is evident that the high cost is one of the biggest factors attributing to the lack of access to healthcare in the African American community. Although there are different initiatives that have been put in place to address this disparity, the outcome has not been according to the expectation. The Affordable Care Act and “Equal treatment: Confronting Racial and Ethnic Disparities in Care” initiatives have not completely solved the problem of disparity in accessibility to healthcare because they do not touch the gist of the problem, which is poverty. In this regard, it would be important to address the issue of poverty and income inequality between African Americans and Whites. If a large number of African Americans can be helped out of poverty, their income can finance insurance coverage. This can put them in a position to access health care services despite the high costs, thus reducing disparity in access to healthcare services.

 

References

Duckett, P., & Artiga, S. (2013, July 24). Health Coverage for the Black Population Today and Under the Affordable Care Act. Retrieved from https://www.kff.org/disparities-policy/fact-sheet/health-coverage-for-the-black-population-today-and-under-the-affordable-care-act/

McMorrow, S., Long, S. K., Kenney, G. M., & Anderson, N. (2015). Uninsurance Disparities Have Narrowed for Black and Hispanic Adults under the Affordable Care Act. Health Affairs34(10), 1774-1778. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0757

Noonan, A. S., Velasco-Mondragon, H. E., & Wagner, F. A. (2016). Improving the Health of African Americans in the USA: An Overdue Opportunity for Social Justice. Public Health Reviews37(1), 12. Retrieved from https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-016-0025-4

NORC (2018). Americans’ Views of Healthcare Costs, Coverage, and Policy. West Health Institute. Retrieved from http://www.norc.org/PDFs/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy%20Issue%20Brief.pdf

Riley, P., Hayes, S. L., & Ryan, J. (2016, July 15). Closing the Equity Gap in Health Care for Black Americans. Retrieved from https://www.commonwealthfund.org/blog/2016/closing-equity-gap-health-care-black-americans

Sohn, H. (2017). Racial and ethnic disparities in health insurance coverage: Dynamics of gaining and losing coverage over the life-course. Population research and policy review36(2), 181-201. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370590/