Socio-economic inequality and its impact on specific groups in the USAHealth inequalities

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.

Most Americans are expected to provide for their own health care through private medical insurance. Many people receive their private health insurance through their employer. One of the providers is the Blue Cross Blue Shield Association, which provided health insurance for 115 million members as of 2023.

The US government has health programmes that cover those who cannot afford private medical insurance. These include:

• Medicare – mostly for people over 65 years of age and administered by federal government. In 2022, Medicare covered 65 million people and cost $905 billion.
• Medicaid – covers people on low incomes including children, pregnant women and people with disabilities. It is administered by individual states. In 2023, 83 million individuals were enrolled in Medicaid costing the US government $805 billion.
• Children’s Health Insurance Program – covers those children who do not qualify for Medicaid. CHIP is administered by states. In 2023, nearly seven million children were enrolled in CHIP.

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 (paperwork) costs are high
• Salaries of doctors and registered nurses are higher than elsewhere in the world
• US prescription drugs cost two to three times more than other developed countries
• 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

Black and Hispanic Americans are more likely to have lower incomes or to be unemployed. This means that they are less likely to have private medical insurance and are more likely to depend on Medicare or Medicaid or to be underinsured (partly insured) or uninsured (not covered by government health programmes and without private medical insurance). In 2023, 26 million people — or 7.9 percent of the population – were uninsured.