Health Care Barriers to Change Essay ⋆ Essays on Controversial Topics ⋆ EssayEmpire

Researchers consistently document U.S. disparities in health care access according to race and ethnicity, socioeconomic status, gender, sexual orientation, and disability. Inadequate health care access contributes to poor health outcomes over the life course, leading to higher incidence of disease and chronic conditions and, consequently, to lower life expectancy among some population segments. Although a leader in technological innovation and development and among the highest in per capita health care expenditures, the United States consistently ranks among the worst in national health and health care outcomes compared with other developed countries. In 2006, U.S. Census Bureau estimates placed the number of non-elderly uninsured at approximately 46.1 million, a figure that does not include individuals experiencing discontinuous coverage. Further, costs continue to rise due to increases in chronic health conditions, an influx of expensive new technologies, and expanding definitions of what is medically treatable.

Policymakers, health professionals, consumers, and others recognize the need to reform the U.S. health care system. Strategies to improve health care quality generally take the form of incremental changes to the structure of health care financing or introduction and improvement of health care quality data collection and feedback mechanisms. Still, health care quality improvements from these reforms have been modest. Critics argue that these reform efforts neglect existing sets of beliefs at institutional and interpersonal levels that both impede meaningful health care reform and maintain the current system of inequitable care delivery. The failure of reform efforts points to the need to identify and understand ideological barriers to health care change.

Health Care Reform

Many argue that the only way the United States can achieve substantial improvements in health care quality is through the development of national health insurance (NHI). Successful adoption of NHI would establish the right to health care. Despite high levels of support for some sort of NHI among the public, previous efforts to institute NHI failed. Historically, labor unions and physician opposition, concretized in the lobbying efforts of the American Medical Association, helped undermine early reform efforts. Conservative political opposition, frequently aligned with the Republican Party, also rejects the notion that health care is a right, preferring to treat health care like other goods and services optimally provided through competitive markets. In support of this perspective, the American Medical Association, conservatives, and other opponents have been successful in mobilizing “myths” about the quality of the U.S. health care system as rhetorical devices to persuade policymakers that NHI is simply not a politically feasible option. These myths play upon commonsense beliefs about the U.S. health care system, including generalized beliefs that U.S. health care is “the best in the world,” any existing problems are “not that bad,” and the best solutions to any problems lie in privatization and the market. The dominance of such ideologies has led to the failure of significant reform attempts, ensuring that the current system of health care rationing, according to ability to pay rather than clinical need, continues.

Health Care Access and Quality

A growing body of evidence suggests that even with the adoption of reforms such as NHI, inequities in the delivery of health care will persist. Some argue that a major problem overlooked by most reform efforts is the chronic undersupply of minority and female physicians. Regardless of good intentions, a health care delivery system reliant upon physicians who are, by and large, white, upper-class, able-bodied, and heterosexual males will inevitably yield poorer health care outcomes for patients who fall outside these categories. Others argue that even if a ready supply of physicians outside these privileged groups existed, inequities sustained by the existing system of medical beliefs remain unaddressed. These barriers stem from the nature of medical training and the ways in which medical knowledge is applied within health care delivery. Medical professionals are trained to complete the process of diagnosis and treatment by taking symptoms presented by a patient and using them as clues to construct a diagnosis for which they can then prescribe treatment. Thus, patients who receive the best care are those who can most skillfully cooperate in the construction of these standardized medical narratives. Patients who are unfamiliar with the appropriate medical terms and phrases, whose cases are complicated, or who attempt to present alternative narratives to the standard medical ones are less likely to receive good care.

Ideological barriers to improvements in the U.S. health care system do not exist solely in the opposition to large-scale policy reform but also in health care delivery. Traditionally, research limited its focus to structural barriers such as health care financing and discrimination in patient-provider interactions. At the level of patient-provider interactions, the focus has been on difficulties arising from factors such as differences in communication styles due to class, race, or gender, or from conscious or subconscious discrimination, which can lead to insufficient information or misinformation, improper or inadequate provision of care and referrals for treatment, and erroneous assumptions about either the patient or the provider. Thus, most reforms have addressed financial barriers or training and reporting policies aimed at the prevention of discriminatory practices. Ideological barriers impeding health care reform and enabling gaps in care are the most pervasive yet the most challenging for reformers to address.

Bibliography:

Geyman, John P. 2003. “Myths as Barriers to Health Care Reform in the United States.” International Journal of Health Services 33(2):315-29.
Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, edited by Brian D. Smedley. Washington, DC: National Academies Press.
Mechanic, David. 2006. The Truth about Health Care: Why Reform Is Not Working in America. New Brunswick, NJ: Rutgers University Press.
Schuster, Mark A., Elizabeth A. McGlynn, and Robert H. Brook. 1998. “How Good Is the Quality of Health Care in the United States?” The Milbank Quarterly 76(4):517-63.
Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic Books.

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