Health inequalities

A poster demanding healthcare for everyone, Los Angeles
A poster demanding healthcare for everyone, Los Angeles

Unlike the UK, there is no national health care provision in the USA. A variety of federal government and state-supported health programmes give assistance to the elderly, the poor, and children in less well-off families.

In the USA, most Americans are expected to provide for their own health care through private medical insurance. 58% receive their private health insurance through their employer. Companies such as Blue Cross Blue Shield are among the leading private health care providers.

US government health programmes cover around 28% of the population (83 million people) and include:

  • Medicare – mostly for people over 65 years of age and administered by federal government
  • Medicaid – covers people on low incomes including children, pregnant women and people with disabilities. It is administered by states
  • State Children's Health Insurance Program – covers those children who do not qualify for Medicaid

Until recently, around 45 million Americans (15% of the population) had no private health insurance and did not qualify for Medicaid. The numbers of uninsured Americans increased as access to healthcare became increasingly unaffordable and many employers were reducing the coverage they provided to workers.

Problems with the US healthcare system

The US healthcare system can work well for those with full coverage private medical insurance. Facilities and treatments are world-class, public satisfaction rates are high and waiting times are low.

However:

  • despite spending proportionally the most money on healthcare in the world, outcomes e.g. life expectancy and infant mortality, are poorer than many other developed countries
  • there is a great deal of inefficiency in the US health care system as companies compete for business and bureaucracy (paper work) costs are high
  • around 1.5 million Americans lose their homes every year due to unaffordable medical costs
  • there are few incentives to promote health education

Impact of US healthcare system on minority groups

In America, African American and Hispanic people are more likely to have lower incomes or to be unemployed. They are therefore less likely to have private medical insurance. They are also more likely to depend on Medicare or to be uninsured.