World News – United States – 5 Ways the Healthcare System Can Stop Amplifying Racism


The coronavirus pandemic has not created health disparities among Americans, but it has once again shown just how serious the problem is Black and Latino patients are two to three times more likely than white patients to be diagnosed with COVID-19, and more than four times more likely to be hospitalized for it Black patients are more than twice as likely to die from the virus They also die at younger ages COVID-19 has exacerbated long-standing trends: Black Americans and Latin Americans have lower insurance coverage rates, higher prevalence of chronic disease, worse health outcomes and shorter life expectancy People in the health care world sometimes talk about these patterns as if they were inevitable facts of life – something the industry is powerless to change More doctors and hospitals must recognize and abide by. rder the way the US healthcare system is plagued by structural racism For decades, American medicine has discriminated against people of color

The health care system, according to one estimate, is responsible for only about 10 to 15 percent of preventable mortality in the United States Socio-economic factors, such as housing, food and education , have a greater overall impact Policies that effectively address these factors will be needed to dramatically reduce health disparities for Blacks and Latinos.Nevertheless, many choices that healthcare professionals commonly make – such as not to accepting Medicaid patients, having fewer staff in minority neighborhood facilities, and blaming patients for not taking their medications and for poor overall outcomes – perpetuate the disparities and even amplify them

These health gaps are not immutable Concrete changes in public policy, industry practices and medical education could make the health care system a force for greater equality Here are five of these changes:

First, when states are indifferent to whether their black and Latino citizens have health coverage, the federal government should step in According to a study released earlier this year, 9% of white adults were uninsured in 2018, compared to 14% of black adults and 25% of Latino adults Coronavirus Recession Worsens Coverage Gap Up To 12 Million Americans Have Already Lost Insurance Sponsored By Their Employer Or The Employer Of A Family Member Black, Latino And Other Colored Workers Have Been Confronted a particularly marked drop in employment

The Affordable Care Act narrowed insurance disparities by establishing insurance scholarships and making more Americans eligible for Medicaid, but some states have opted out, with terrible consequences for disadvantaged minorities Indeed, an estimated 46% of black working-age adults live in the 15 states that have refused to implement the ACA’s expanded Medicaid benefits, leaving low-wage workers with no way to pay for their care. family The disparity increases as unemployment increases: Medicaid covers 36% of unemployed adults in states that have expanded program eligibility, but only 16% in states that have not

So far, federal incentives have not been enough to convince states like Texas, Georgia and Florida to expand Medicaid The next President and Congress may fix this problem by federalizing Medicaid and withdrawing his state administration Such a change could result in universal enrollment standards and dramatically narrow the racial gap in health insurance

Second, policymakers can make sense of insurance coverage by asking Medicaid to pay doctors and hospitals more Health coverage is necessary, but not sufficient, for patients to get good health care in Timely Because Medicaid pays physicians less than Medicare or private insurance, many physicians refuse to see or delay Medicaid patient appointments.A survey conducted in 2014-2015 showed that only 68% of family physicians agreed new Medicaid patients, while 91% accepted those with private insurance Some doctors did not accept new patients at all or did not accept insurance Only a third of psychiatrists accepted new Medicaid patients

In 2013 and 2014, ACA temporarily increased Medicaid payments to primary care physicians This fee increase improved patient access to physicians Equally predictably, when states returned to higher fee levels low, Medicaid registrants found it harder to book appointments The lesson is clear: Federal government must continuously increase Medicaid payments to doctors For hospitals, payment reforms should penalize poor performance on measures health equity For example, higher payments to hospitals could be linked to improved emergency room wait times, which have often been shown to be longer for black patients than for whites

Third, hospitals – which often anchor a community’s health system – need to address the social factors that affect health outcomes Hospitals that do so could reap long-term benefits In the middle 2000s, for example, Boston Children’s Hospital initiated a community outreach program for low-income black and Latino children who, based on previous information, appeared likely to be hospitalized with asthma. Social workers worked with families and community groups to reduce the prevalence of conditions that lead to asthma attacks The result: unnecessary readmissions, emergency room visits, missed school days by students and days off. Parents’ lost work all plummeted The program generated $ 1 73 in benefits for every dollar spent In various other hospitals, initiatives to tackle the social determinants of health led to a drop in readmissions

Government exerts influence over hospitals In return for avoiding substantial federal and state taxes, nonprofit hospitals are required to provide community benefits Many hospitals count discounted care for Medicaid and patients uninsured as community benefits Instead, state and federal policies should specifically encourage hospitals to invest in community health – for example, in anti-hunger programs or « nurse-family partnerships » that help low income mothers Many hospitals also receive additional funds because they operate in low-income communities, earn less from private insurance, and provide a disproportionate share of their services to patients who do not have the capacity to pay. These government payments should be linked to investments that target the social determinants of health

Fourth, increasing diversity among doctors and nurses is essential In an experiment in Oakland, Calif., researchers Marcella Alsan, Owen Garrick and Grant C Graziani found that the involvement of black doctors could reduce the cardiovascular mortality gap between black and white men of 19% Yet only 5% of American doctors are black, compared to 13% of the general population Latino and indigenous doctors are also under-represented Structural barriers, including excessive cost of obtaining a medical or nursing degree, and prejudices in the admissions process, contribute significantly to this lack of diversity Many states already offer loan repayment services and other incentives for physicians work in underserved areas, but expansion of these programs could recruit even more under-represented minorities in the field medical Not all barriers to diversity are economic, of course Minority students are also more likely to experience discriminatory comments and public humiliation during their medical education Medical schools and hospitals must take serious disciplinary action for such behavior, while ensuring that students who complain are not labeled « troublemakers » « 

Finally, all health workers could also benefit from a program that specifically addresses the implicit prejudices and historical roots of racism in the medical system To this day, medical textbooks still describe predominantly white skin tones. medical students have empirically false beliefs about physiological differences based on race, including the notion that black patients have greater pain tolerance than white patients These beliefs affect the type of decisions doctors make at the start of the pandemic found that doctors were less likely to refer symptomatic black patients for testing than they were white patients Educating aspiring physicians on these dynamics will improve the care patients receive

These five steps won’t address health disparities in the United States, but they outline a course of action Reducing Racial Bias in Health Care Will Have Broad Benefits: A Country Whose Residents Suffer From less chronic disease, better access to care and a longer life has a greater capacity for happiness and prosperity As America faces a national toll with structural racism, leaders of the health system health must face the role we play and take responsibility for solving the problem

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