The Socio-Economic Dimensions of Health Care Access in the USA

In the Washington Post article (12/21/2004) Dying For Basic Care by January W. Payne:

More than 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same care as whites, according to an analysis in the December issue of the American Journal of Public Health. The study estimates that technological improvements in medicine -- including better drugs, devices and procedures -- averted only 176,633 deaths during the same period.

What is connection between race (or, for that matter, ethnicity) and mortality rates?  This is laid out clear in the document titled Income, Poverty, and Health Insurace Coverage in the United States: 2003.  The first piece of information shows the median money household income by race, ethnicity and age of head of household.  Black and Hispanic household, and the very young and old households make significantly less money than the total population.

(source:  US Census Bureau)

The second subject mentioned in the title of the document is poverty.  There is a formal definition given by the Office of Management and Budget.  The key ingredient is based upon the household size, on the grounds that a household with one person get by with less income than one with five person.  For the year 2003, the average poverty thresholds are as follows:

When a household's total income is less than that the official poverty, the household and every individual is considered in poverty.  In the next chart, we show the poverty incidences by race, ethnicity and age of the people.  The connection is obvious: if you don't earn money, you are likely to be classified as poor.

(source:  US Census Bureau)

The last subject mentioned in the title is health insurance.  For reporting purposes, the Census Bureau broadly classifieds health insurance coverage as private or government coverage.  Private health insurance is covered by a plan provided through an employer or union or purchased by an individual from a private company.  Government health insurance includes the federal programs Medicare, Medicaid, and military health care; the State Children's Health Insurance Program (SCHIP); and individual state health plans.  The next chart shows the incidence of people without health insurance by race, ethnicity, age and household income.  By far, the strongest relationship is with household income.  If you do not have enough money, you cannot buy private insurance; if you are not working full-time for a large company, you do not get company coverage.

(source:  US Census Bureau)

The last piece of information comes from the 2004 MARS OTC/DTC Pharmaceutical Study.  This is a mail survey of 21,054 adults in the United States conducted during the first quarter of 2004.  

For the purpose of comparison first, we look first the the incidence of people without health insurance.  The next chart belows shows the MARS data by race, ethnicity and household income.  The overall incidence of 17.0 is within the bounds of sampling/measurement error of the US Census Burea data (which are based upon the Current Population Survey).  The MARS data contains greater detail by household income, and this is where there is an oddity about a small surge at the upper end of the scale.  If you think about it, anyone who has a few million in assets is unlikely to get medical coverage through a HMO where they will have to get on a queue to get treatment; more likely, they are going to pay their own way with the best private doctors.

(source:  2004 MARS)

From within the MARS study, we will focus on a preventable and treatable physical ailment: nutritional deficiency. 

Among those who have health insurance, 0.8% of them have suffered from nutritional definiency in the last twelve months.  Among those who do not have health insurance, 2.2% of them have suffered from nutritional deficiency.  As we said, this is a preventable physical ailment, and the incidence is very much related to socio-economic level.

Among those who have nutritional defiency with health insurance, 13.8% said that they had no treatment during those 12 months.  Among those who have nutritional disease but do not have health insurance, 22.8% said that they had no treatment during those 12 months.  While nutritional deficiency is a treatable physical ailment, treatment also costs money.

As is typical with documents from the US Census, there are no policy implications being drawn.  The data are presented in tabular and graphical form, and the accompanying text simply describes what is seen.  By contrast, the Washington Post quotes the AJPH study's conclusion: ""Socioeconomic conditions represent a more pertinent cause of disparities than race.  An intriguing question is whether more lives are saved by medical advances or by resolving social inequities in education and income."

(posted by Roland Soong, 12/31/2004)

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