Healthcare Disparities: Minority Populations
Introduction

The United States is a major world power and a major industrialized nation. Despite this fact, its healthcare system does not provide universal access to care, in stark contrast to most other affluent world powers. Some citizens have access to highly comprehensive insurance through their employers while others do not. Certain low-income individuals qualify for either subsidized insurance through the Affordable Care Act (ACA) or for Medicaid, the state-administered healthcare insurance program for the poor that is partially federally funded. The disparate ways in which healthcare insurance is provided in the United States often results in highly disparate allocations of care to individuals. But even when patients have insurance, cultural, linguistic, and psychological barriers can further exacerbate equal access to care for minority populations.

Definition

The existence of healthcare disparities in the United States has been well-documented. Not only are certain illnesses such as diabetes and heart disease more prevalent in economically and historically discriminated-against populations, but as noted by Gollust (et al., 2018), they can take the form of personal psychological indignities inflicted by the healthcare system. In a mixed methods research study of 53 health providers at a Veteran’s Health Administration facility, one African-American providers described experiencing personal discrimination when seeking treatment for back pain, noting that his concerns was not regarded as valid; another provider stated he perceived that due to unconscious bias “white patients may be given the benefit of the doubt” when complaining about symptoms members of other population groups were not (Gollust, et al., 2018, p.7). Even if providers are not consciously aware of biases, unconscious biases were seen as significantly contributing to healthcare disparities in the form of invisible barriers to care.

Factors Impacting the Issue

Data suggests that socioeconomic status and race are two of the biggest factors which can impede equal access to health services, even in a post-ACA world. This is particularly the case in regards to mental healthcare which is often not perceived as a necessity in the same manner as primary, physical care. Yet inadequate treatment for mental health has been linked to poorer physical health, given that people who struggle with mental illnesses often struggle to find employment or to maintain a functional state of personal care. The descriptive research study by Jones (et al., 2018) found that even after the ACA became law, significant disparities based upon race and income were manifested in access to mental healthcare services, despite the fact that the ACA mandated psychiatric coverage for all healthcare plans offered to consumers.

Researchers obtained data from the Medical Expenditures Panel Survey (MEPS). Of the 2747 subjects with severe mental health issues, all members of the historically discriminated-against racial groups were found to be less likely to see a primary care provider for physical health issues...…are often the most in need of support and outreach.

A final barrier to care identified by Tan-McGrory (et al., 2018) by the interviewed providers was ensuring which parents had the authority to make healthcare decisions, given the increasingly bifurcated nature of the modern family. Many parents may remarry, or children may be cared for by grandparents in addition to parents. As families age, older patients may likewise have caregivers with different ideas about how to manage care, and this can create disparities of care when there are conflicts and miscommunications. Patients with multiple complex conditions seeing different providers may receive conflicting and incomplete advice due to a lack of communication channels (Tan-McGrory, et al., 2018). But simply because the patient is not a member of a standard nuclear family or has an unusual or complex medical condition does not mean he or she is not entitled to the same type of care and the same quality of care as other patients.

The Impact on Nursing

Although on an individual basis, nurses cannot always provide a comprehensive solution, multicultural competence can be significant in overcoming psychological barriers to accessing care. Offering linguistically competent care, taking patients’ concerns seriously, and being aware of how disparities of income and past prejudices have generated negative experiences with the healthcare profession are all necessary for the nurse to offer care in a truly compassionate and culturally fluent manner.

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