{"id":280,"date":"2021-03-16T14:50:26","date_gmt":"2021-03-16T14:50:26","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&#038;p=280"},"modified":"2021-03-16T14:50:39","modified_gmt":"2021-03-16T14:50:39","slug":"disparities-in-access-to-health-care","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/disparities-in-access-to-health-care\/","title":{"raw":"Disparities in access to health care","rendered":"Disparities in access to health care"},"content":{"raw":"Reasons for disparities in access to health care are many, but can include the following:\r\n<ul>\r\n \t<li>Lack of\u00a0<a title=\"Universal health care\" href=\"https:\/\/en.wikipedia.org\/wiki\/Universal_health_care\">universal health care<\/a>\u00a0or\u00a0<a title=\"Health insurance\" href=\"https:\/\/en.wikipedia.org\/wiki\/Health_insurance\">health insurance<\/a>\u00a0coverage. Without health insurance, patients are more likely to postpone medical care, go without needed medical care, go without prescription medicines, and be denied access to care.<sup id=\"cite_ref-126\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-126\">[126]<\/a><\/sup>\u00a0Minority groups in the United States lack insurance coverage at higher rates than whites.<sup id=\"cite_ref-127\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-127\">[127]<\/a><\/sup>\u00a0This problem does not exist in countries with fully funded public health systems, such as the examplar of the\u00a0<a title=\"National Health Service\" href=\"https:\/\/en.wikipedia.org\/wiki\/National_Health_Service\">NHS<\/a>.<\/li>\r\n \t<li>Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use\u00a0<a class=\"mw-redirect\" title=\"Emergency rooms\" href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_rooms\">emergency rooms<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Clinics\" href=\"https:\/\/en.wikipedia.org\/wiki\/Clinics\">clinics<\/a>\u00a0as their regular source of care.<sup id=\"cite_ref-128\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-128\">[128]<\/a><\/sup>\u00a0In the United Kingdom, which is much more racially harmonious, this issue arises for a different reason; since 2004, NHS\u00a0<a class=\"mw-redirect\" title=\"General practitioners\" href=\"https:\/\/en.wikipedia.org\/wiki\/General_practitioners\">GPs<\/a>\u00a0have not been responsible for care out of normal GP surgery opening hours, leading to significantly higher attendances in\u00a0<a title=\"Emergency department\" href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_department\">A+E<\/a><\/li>\r\n \t<li>Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.<sup id=\"cite_ref-129\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-129\">[129]<\/a><\/sup><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Legal\" href=\"https:\/\/en.wikipedia.org\/wiki\/Legal\">Legal<\/a>\u00a0barriers. Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs. For example, in the United States federal law bars states from providing\u00a0<a title=\"Medicaid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medicaid\">Medicaid<\/a>\u00a0coverage to\u00a0<a class=\"mw-redirect\" title=\"Immigrants\" href=\"https:\/\/en.wikipedia.org\/wiki\/Immigrants\">immigrants<\/a>\u00a0who have been in the country fewer than five years.<sup id=\"cite_ref-Goldberg,_J._2004_page_10_130-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Goldberg,_J._2004_page_10-130\">[130]<\/a><\/sup>\u00a0Another example could be when a non-English speaking person attends a clinic where the receptionist does not speak the person's language. This is mostly seen in Hispanic people who do not speak English.<\/li>\r\n \t<li>Structural barriers. These barriers include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person's ability and willingness to obtain needed care.<sup id=\"cite_ref-131\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-131\">[131]<\/a><\/sup><\/li>\r\n \t<li>The health care financing system. The\u00a0<a class=\"mw-redirect\" title=\"Institute of Medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Institute_of_Medicine\">Institute of Medicine<\/a>\u00a0in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.<sup id=\"cite_ref-Goldberg,_J._2004_page_10_130-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Goldberg,_J._2004_page_10-130\">[130]<\/a><\/sup><\/li>\r\n \t<li>Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.<sup id=\"cite_ref-K._Collins,_D._Hughes_2002_132-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-K._Collins,_D._Hughes_2002-132\">[132]<\/a><\/sup>\u00a0In the UK,\u00a0<a title=\"Monitor (NHS)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Monitor_(NHS)\">Monitor<\/a>\u00a0(a\u00a0<a title=\"Quango\" href=\"https:\/\/en.wikipedia.org\/wiki\/Quango\">quango<\/a>) has a legal obligation to ensure that sufficient provision exists in all parts of the nation.<\/li>\r\n \t<li>Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not\u00a0<a title=\"English language\" href=\"https:\/\/en.wikipedia.org\/wiki\/English_language\">English<\/a>-proficient.<sup id=\"cite_ref-133\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-133\">[133]<\/a><\/sup><\/li>\r\n \t<li>Health\u00a0<a title=\"Literacy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Literacy\">literacy<\/a>. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.<sup id=\"cite_ref-K._Collins,_D._Hughes_2002_132-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-K._Collins,_D._Hughes_2002-132\">[132]<\/a><\/sup>\u00a0A study conducted in Mdantsane, South Africa depicts the correlation of maternal education and the antenatal visits for pregnancy. As patients have a greater education, they tend to use maternal health care services more than those with a lesser maternal education background.<sup id=\"cite_ref-134\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-134\">[134]<\/a><\/sup><\/li>\r\n \t<li>Lack of\u00a0<a title=\"Multiculturalism\" href=\"https:\/\/en.wikipedia.org\/wiki\/Multiculturalism\">diversity<\/a>\u00a0in the health care workforce. A major reason for disparities in access to care are the\u00a0<a class=\"mw-redirect\" title=\"Cultural\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cultural\">cultural<\/a>\u00a0differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups' proportion of the United States population.<sup id=\"cite_ref-135\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-135\">[135]<\/a><\/sup><\/li>\r\n \t<li>Age. Age can also be a factor in health disparities for a number of reasons. As many older Americans exist on fixed incomes which may make paying for health care expenses difficult. Additionally, they may face other barriers such as impaired mobility or lack of transportation which make accessing health care services challenging for them physically. Also, they may not have the opportunity to access health information via the internet as less than 15% of Americans over the age of 65 have access to the internet.<sup id=\"cite_ref-136\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-136\">[136]<\/a><\/sup>\u00a0This could put older individuals at a disadvantage in terms of accessing valuable information about their health and how to protect it. On the other hand, older individuals in the US (65 or above) are provided with medical care via\u00a0<a title=\"Medicare (United States)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medicare_(United_States)\">Medicare<\/a>.<\/li>\r\n \t<li>Criminalization and lack of research of\u00a0<a title=\"Traditional medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Traditional_medicine\">traditional medicine<\/a>,<sup id=\"cite_ref-137\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-137\">[137]<\/a><\/sup>\u00a0and mental health treatments.<sup id=\"cite_ref-138\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-138\">[138]<\/a><\/sup>\u00a0Mental illness accounts for about one-third of adult disability globally.<sup id=\"cite_ref-139\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-139\">[139]<\/a><\/sup>\u00a0Conventional drug treatments have dominated psychiatry for decades, without a breakthrough in mental healthcare. Access to\u00a0<a title=\"Psychedelic therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psychedelic_therapy\">psychedelic-assisted therapy<\/a>, and the\u00a0<a title=\"Psilocybin decriminalization in the United States\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psilocybin_decriminalization_in_the_United_States\">decriminalization of Psilocybin<\/a>\u00a0and other\u00a0<a title=\"Entheogen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Entheogen\">entheogens<\/a>\u00a0are questions of health justice.<sup id=\"cite_ref-140\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-140\">[140]<\/a><\/sup><\/li>\r\n<\/ul>\r\n<h3><span id=\"Dental_healthcare\" class=\"mw-headline\">Dental healthcare<\/span><\/h3>\r\nIn many countries, dental healthcare is less accessible than other kinds of healthcare. In Western countries, dental healthcare providers are present, and private or public healthcare systems typically facilitate access. However, access remains limited for marginalized groups such as the homeless, racial minorities, and those who are homebound or disabled. In Central and Eastern Europe, the privatization of dental healthcare has resulted in a shortage of affordable options for lower-income people. In Eastern Europe, school-age children formerly had access through school programs, but these have been discontinued. Therefore, many children no longer have access to care. Access to services and the breadth of services provided is greatly reduced in developing regions. Such services may be limited to emergency care and pain relief, neglecting preventative or restorative services. Regions like Africa, Asia, and Latin America do not have enough dental health professionals to meet the needs of the populace. In Africa, for example, there is only one dentist for every 150,000 people, compared to industrialized countries which average one dentist per 2,000 people.<sup id=\"cite_ref-141\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-141\">[141]<\/a><\/sup>\r\n<h2><span id=\"Disparities_in_quality_of_health_care\" class=\"mw-headline\">Disparities in quality of health care<\/span><\/h2>\r\nHealth disparities in the quality of care exist and are based on language and ethnicity\/race which includes:\r\n<h3><span id=\"Problems_with_patient-provider_communication\" class=\"mw-headline\">Problems with patient-provider communication<\/span><\/h3>\r\nCommunication is critical for the delivery of appropriate and effective treatment and care, regardless of a patient\u2019s race, and miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care. The patient provider relationship is dependent on the ability of both individuals to effectively communicate. Language and culture both play a significant role in communication during a medical visit. Among the patient population, minorities face greater difficulty in communicating with their physicians. Patients when surveyed responded that 19% of the time they have problems communicating with their providers which included understanding doctor, feeling doctor listened, and had questions but did not ask.<sup id=\"cite_ref-Health_Care_Quality_Survey_142-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Health_Care_Quality_Survey-142\">[142]<\/a><\/sup>\u00a0In contrast, the Hispanic population had the largest problem communicating with their provider, 33% of the time.<sup id=\"cite_ref-Health_Care_Quality_Survey_142-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Health_Care_Quality_Survey-142\">[142]<\/a><\/sup>\u00a0Communication has been linked to health outcomes, as communication improves so does patient satisfaction which leads to improved compliance and then to improved health outcomes.<sup id=\"cite_ref-143\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-143\">[143]<\/a><\/sup>\u00a0Quality of care is impacted as a result of an inability to communicate with health care providers. Language plays a pivotal role in communication and efforts need to be taken to ensure excellent communication between patient and provider. Among\u00a0<a title=\"Limited English proficiency\" href=\"https:\/\/en.wikipedia.org\/wiki\/Limited_English_proficiency\">limited English proficient<\/a>\u00a0patients in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during clinical visits report having one. The absence of interpreters during a clinical visit adds to the communication barrier. Furthermore, inability of providers to communicate with limited English proficient patients leads to more diagnostic procedures, more invasive procedures, and over prescribing of medications.<sup id=\"cite_ref-144\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-144\">[144]<\/a><\/sup>\u00a0Language barriers have not only hindered appointment scheduling, prescription filling, and clear communications, but have also been associated with health declines, which can be attributed to reduced compliance and delays in seeking care, which could affect particularly\u00a0<a title=\"Refugee health in the United States\" href=\"https:\/\/en.wikipedia.org\/wiki\/Refugee_health_in_the_United_States\">refugee health in the United States<\/a>.\u00a0<sup id=\"cite_ref-145\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-145\">[145]<\/a><\/sup><sup id=\"cite_ref-146\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-146\">[146]<\/a><\/sup>\u00a0Many health-related settings provide interpreter services for their limited English proficient patients. This has been helpful when providers do not speak the same language as the patient. However, there is mounting evidence that patients need to communicate with a language concordant physician (not simply an interpreter) to receive the best medical care, bond with the physician, and be satisfied with the care experience.<sup id=\"cite_ref-147\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-147\">[147]<\/a><\/sup><sup id=\"cite_ref-148\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-148\">[148]<\/a><\/sup>\u00a0Having patient-physician language discordant pairs (i.e. Spanish-speaking patient with an English-speaking physician) may also lead to greater medical expenditures and thus higher costs to the organization.<sup id=\"cite_ref-149\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-149\">[149]<\/a><\/sup>\u00a0Additional communication problems result from a decrease or lack of cultural competence by providers. It is important for providers to be cognizant of patients\u2019 health beliefs and practices without being judgmental or reacting. Understanding a patients\u2019 view of health and disease is important for diagnosis and treatment. So providers need to assess patients\u2019 health beliefs and practices to improve quality of care.<sup id=\"cite_ref-150\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-150\">[150]<\/a><\/sup>\u00a0Patient health decisions can be influenced by religious beliefs, mistrust of Western medicine, and familial and hierarchical roles, all of which a white provider may not be familiar with.<sup id=\"cite_ref-151\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-151\">[151]<\/a><\/sup>\u00a0Other type of communication problems are seen in LGBT health care with the spoken heterosexist (conscious or unconscious) attitude on LGBT patients, lack of understanding on issues like having no sex with men (lesbians, gynecologic examinations) and other issues.<sup id=\"cite_ref-152\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-152\">[152]<\/a><\/sup>\r\n<h3><span id=\"Provider_discrimination\" class=\"mw-headline\">Provider discrimination<\/span><\/h3>\r\nProvider\u00a0<a title=\"Discrimination\" href=\"https:\/\/en.wikipedia.org\/wiki\/Discrimination\">discrimination<\/a>\u00a0occurs when health care providers either unconsciously or consciously treat certain racial and ethnic patients differently from other patients. This may be due to stereotypes that providers may have towards ethnic\/racial groups. A March, 2000 study from Social Science &amp; Medicine suggests that doctors may be more likely to ascribe negative racial stereotypes to their minority patients.<sup id=\"cite_ref-153\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-153\">[153]<\/a><\/sup>\u00a0This may occur regardless of consideration for education, income, and personality characteristics. Two types of stereotypes may be involved,\u00a0<a title=\"Implicit stereotype\" href=\"https:\/\/en.wikipedia.org\/wiki\/Implicit_stereotype\">automatic stereotypes<\/a>\u00a0or goal modified stereotypes. Automated stereotyping is when stereotypes are automatically activated and influence judgments\/behaviors outside of consciousness.<sup id=\"cite_ref-Burgess_2006_119\u2013134_154-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Burgess_2006_119%E2%80%93134-154\">[154]<\/a><\/sup>\u00a0Goal modified stereotype is a more conscious process, done when specific needs of clinician arise (time constraints, filling in gaps in information needed) to make a complex decisions.<sup id=\"cite_ref-Burgess_2006_119\u2013134_154-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Burgess_2006_119%E2%80%93134-154\">[154]<\/a><\/sup>\u00a0Physicians are unaware of their implicit biases.<sup id=\"cite_ref-155\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-155\">[155]<\/a><\/sup>\u00a0Some research suggests that ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.<sup id=\"cite_ref-156\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-156\">[156]<\/a><\/sup>","rendered":"<p>Reasons for disparities in access to health care are many, but can include the following:<\/p>\n<ul>\n<li>Lack of\u00a0<a title=\"Universal health care\" href=\"https:\/\/en.wikipedia.org\/wiki\/Universal_health_care\">universal health care<\/a>\u00a0or\u00a0<a title=\"Health insurance\" href=\"https:\/\/en.wikipedia.org\/wiki\/Health_insurance\">health insurance<\/a>\u00a0coverage. Without health insurance, patients are more likely to postpone medical care, go without needed medical care, go without prescription medicines, and be denied access to care.<sup id=\"cite_ref-126\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-126\">[126]<\/a><\/sup>\u00a0Minority groups in the United States lack insurance coverage at higher rates than whites.<sup id=\"cite_ref-127\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-127\">[127]<\/a><\/sup>\u00a0This problem does not exist in countries with fully funded public health systems, such as the examplar of the\u00a0<a title=\"National Health Service\" href=\"https:\/\/en.wikipedia.org\/wiki\/National_Health_Service\">NHS<\/a>.<\/li>\n<li>Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use\u00a0<a class=\"mw-redirect\" title=\"Emergency rooms\" href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_rooms\">emergency rooms<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Clinics\" href=\"https:\/\/en.wikipedia.org\/wiki\/Clinics\">clinics<\/a>\u00a0as their regular source of care.<sup id=\"cite_ref-128\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-128\">[128]<\/a><\/sup>\u00a0In the United Kingdom, which is much more racially harmonious, this issue arises for a different reason; since 2004, NHS\u00a0<a class=\"mw-redirect\" title=\"General practitioners\" href=\"https:\/\/en.wikipedia.org\/wiki\/General_practitioners\">GPs<\/a>\u00a0have not been responsible for care out of normal GP surgery opening hours, leading to significantly higher attendances in\u00a0<a title=\"Emergency department\" href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_department\">A+E<\/a><\/li>\n<li>Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.<sup id=\"cite_ref-129\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-129\">[129]<\/a><\/sup><\/li>\n<li><a class=\"mw-redirect\" title=\"Legal\" href=\"https:\/\/en.wikipedia.org\/wiki\/Legal\">Legal<\/a>\u00a0barriers. Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs. For example, in the United States federal law bars states from providing\u00a0<a title=\"Medicaid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medicaid\">Medicaid<\/a>\u00a0coverage to\u00a0<a class=\"mw-redirect\" title=\"Immigrants\" href=\"https:\/\/en.wikipedia.org\/wiki\/Immigrants\">immigrants<\/a>\u00a0who have been in the country fewer than five years.<sup id=\"cite_ref-Goldberg,_J._2004_page_10_130-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Goldberg,_J._2004_page_10-130\">[130]<\/a><\/sup>\u00a0Another example could be when a non-English speaking person attends a clinic where the receptionist does not speak the person&#8217;s language. This is mostly seen in Hispanic people who do not speak English.<\/li>\n<li>Structural barriers. These barriers include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person&#8217;s ability and willingness to obtain needed care.<sup id=\"cite_ref-131\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-131\">[131]<\/a><\/sup><\/li>\n<li>The health care financing system. The\u00a0<a class=\"mw-redirect\" title=\"Institute of Medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Institute_of_Medicine\">Institute of Medicine<\/a>\u00a0in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.<sup id=\"cite_ref-Goldberg,_J._2004_page_10_130-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Goldberg,_J._2004_page_10-130\">[130]<\/a><\/sup><\/li>\n<li>Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.<sup id=\"cite_ref-K._Collins,_D._Hughes_2002_132-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-K._Collins,_D._Hughes_2002-132\">[132]<\/a><\/sup>\u00a0In the UK,\u00a0<a title=\"Monitor (NHS)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Monitor_(NHS)\">Monitor<\/a>\u00a0(a\u00a0<a title=\"Quango\" href=\"https:\/\/en.wikipedia.org\/wiki\/Quango\">quango<\/a>) has a legal obligation to ensure that sufficient provision exists in all parts of the nation.<\/li>\n<li>Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not\u00a0<a title=\"English language\" href=\"https:\/\/en.wikipedia.org\/wiki\/English_language\">English<\/a>-proficient.<sup id=\"cite_ref-133\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-133\">[133]<\/a><\/sup><\/li>\n<li>Health\u00a0<a title=\"Literacy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Literacy\">literacy<\/a>. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.<sup id=\"cite_ref-K._Collins,_D._Hughes_2002_132-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-K._Collins,_D._Hughes_2002-132\">[132]<\/a><\/sup>\u00a0A study conducted in Mdantsane, South Africa depicts the correlation of maternal education and the antenatal visits for pregnancy. As patients have a greater education, they tend to use maternal health care services more than those with a lesser maternal education background.<sup id=\"cite_ref-134\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-134\">[134]<\/a><\/sup><\/li>\n<li>Lack of\u00a0<a title=\"Multiculturalism\" href=\"https:\/\/en.wikipedia.org\/wiki\/Multiculturalism\">diversity<\/a>\u00a0in the health care workforce. A major reason for disparities in access to care are the\u00a0<a class=\"mw-redirect\" title=\"Cultural\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cultural\">cultural<\/a>\u00a0differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups&#8217; proportion of the United States population.<sup id=\"cite_ref-135\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-135\">[135]<\/a><\/sup><\/li>\n<li>Age. Age can also be a factor in health disparities for a number of reasons. As many older Americans exist on fixed incomes which may make paying for health care expenses difficult. Additionally, they may face other barriers such as impaired mobility or lack of transportation which make accessing health care services challenging for them physically. Also, they may not have the opportunity to access health information via the internet as less than 15% of Americans over the age of 65 have access to the internet.<sup id=\"cite_ref-136\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-136\">[136]<\/a><\/sup>\u00a0This could put older individuals at a disadvantage in terms of accessing valuable information about their health and how to protect it. On the other hand, older individuals in the US (65 or above) are provided with medical care via\u00a0<a title=\"Medicare (United States)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medicare_(United_States)\">Medicare<\/a>.<\/li>\n<li>Criminalization and lack of research of\u00a0<a title=\"Traditional medicine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Traditional_medicine\">traditional medicine<\/a>,<sup id=\"cite_ref-137\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-137\">[137]<\/a><\/sup>\u00a0and mental health treatments.<sup id=\"cite_ref-138\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-138\">[138]<\/a><\/sup>\u00a0Mental illness accounts for about one-third of adult disability globally.<sup id=\"cite_ref-139\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-139\">[139]<\/a><\/sup>\u00a0Conventional drug treatments have dominated psychiatry for decades, without a breakthrough in mental healthcare. Access to\u00a0<a title=\"Psychedelic therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psychedelic_therapy\">psychedelic-assisted therapy<\/a>, and the\u00a0<a title=\"Psilocybin decriminalization in the United States\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psilocybin_decriminalization_in_the_United_States\">decriminalization of Psilocybin<\/a>\u00a0and other\u00a0<a title=\"Entheogen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Entheogen\">entheogens<\/a>\u00a0are questions of health justice.<sup id=\"cite_ref-140\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-140\">[140]<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Dental_healthcare\" class=\"mw-headline\">Dental healthcare<\/span><\/h3>\n<p>In many countries, dental healthcare is less accessible than other kinds of healthcare. In Western countries, dental healthcare providers are present, and private or public healthcare systems typically facilitate access. However, access remains limited for marginalized groups such as the homeless, racial minorities, and those who are homebound or disabled. In Central and Eastern Europe, the privatization of dental healthcare has resulted in a shortage of affordable options for lower-income people. In Eastern Europe, school-age children formerly had access through school programs, but these have been discontinued. Therefore, many children no longer have access to care. Access to services and the breadth of services provided is greatly reduced in developing regions. Such services may be limited to emergency care and pain relief, neglecting preventative or restorative services. Regions like Africa, Asia, and Latin America do not have enough dental health professionals to meet the needs of the populace. In Africa, for example, there is only one dentist for every 150,000 people, compared to industrialized countries which average one dentist per 2,000 people.<sup id=\"cite_ref-141\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-141\">[141]<\/a><\/sup><\/p>\n<h2><span id=\"Disparities_in_quality_of_health_care\" class=\"mw-headline\">Disparities in quality of health care<\/span><\/h2>\n<p>Health disparities in the quality of care exist and are based on language and ethnicity\/race which includes:<\/p>\n<h3><span id=\"Problems_with_patient-provider_communication\" class=\"mw-headline\">Problems with patient-provider communication<\/span><\/h3>\n<p>Communication is critical for the delivery of appropriate and effective treatment and care, regardless of a patient\u2019s race, and miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care. The patient provider relationship is dependent on the ability of both individuals to effectively communicate. Language and culture both play a significant role in communication during a medical visit. Among the patient population, minorities face greater difficulty in communicating with their physicians. Patients when surveyed responded that 19% of the time they have problems communicating with their providers which included understanding doctor, feeling doctor listened, and had questions but did not ask.<sup id=\"cite_ref-Health_Care_Quality_Survey_142-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Health_Care_Quality_Survey-142\">[142]<\/a><\/sup>\u00a0In contrast, the Hispanic population had the largest problem communicating with their provider, 33% of the time.<sup id=\"cite_ref-Health_Care_Quality_Survey_142-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Health_Care_Quality_Survey-142\">[142]<\/a><\/sup>\u00a0Communication has been linked to health outcomes, as communication improves so does patient satisfaction which leads to improved compliance and then to improved health outcomes.<sup id=\"cite_ref-143\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-143\">[143]<\/a><\/sup>\u00a0Quality of care is impacted as a result of an inability to communicate with health care providers. Language plays a pivotal role in communication and efforts need to be taken to ensure excellent communication between patient and provider. Among\u00a0<a title=\"Limited English proficiency\" href=\"https:\/\/en.wikipedia.org\/wiki\/Limited_English_proficiency\">limited English proficient<\/a>\u00a0patients in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during clinical visits report having one. The absence of interpreters during a clinical visit adds to the communication barrier. Furthermore, inability of providers to communicate with limited English proficient patients leads to more diagnostic procedures, more invasive procedures, and over prescribing of medications.<sup id=\"cite_ref-144\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-144\">[144]<\/a><\/sup>\u00a0Language barriers have not only hindered appointment scheduling, prescription filling, and clear communications, but have also been associated with health declines, which can be attributed to reduced compliance and delays in seeking care, which could affect particularly\u00a0<a title=\"Refugee health in the United States\" href=\"https:\/\/en.wikipedia.org\/wiki\/Refugee_health_in_the_United_States\">refugee health in the United States<\/a>.\u00a0<sup id=\"cite_ref-145\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-145\">[145]<\/a><\/sup><sup id=\"cite_ref-146\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-146\">[146]<\/a><\/sup>\u00a0Many health-related settings provide interpreter services for their limited English proficient patients. This has been helpful when providers do not speak the same language as the patient. However, there is mounting evidence that patients need to communicate with a language concordant physician (not simply an interpreter) to receive the best medical care, bond with the physician, and be satisfied with the care experience.<sup id=\"cite_ref-147\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-147\">[147]<\/a><\/sup><sup id=\"cite_ref-148\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-148\">[148]<\/a><\/sup>\u00a0Having patient-physician language discordant pairs (i.e. Spanish-speaking patient with an English-speaking physician) may also lead to greater medical expenditures and thus higher costs to the organization.<sup id=\"cite_ref-149\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-149\">[149]<\/a><\/sup>\u00a0Additional communication problems result from a decrease or lack of cultural competence by providers. It is important for providers to be cognizant of patients\u2019 health beliefs and practices without being judgmental or reacting. Understanding a patients\u2019 view of health and disease is important for diagnosis and treatment. So providers need to assess patients\u2019 health beliefs and practices to improve quality of care.<sup id=\"cite_ref-150\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-150\">[150]<\/a><\/sup>\u00a0Patient health decisions can be influenced by religious beliefs, mistrust of Western medicine, and familial and hierarchical roles, all of which a white provider may not be familiar with.<sup id=\"cite_ref-151\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-151\">[151]<\/a><\/sup>\u00a0Other type of communication problems are seen in LGBT health care with the spoken heterosexist (conscious or unconscious) attitude on LGBT patients, lack of understanding on issues like having no sex with men (lesbians, gynecologic examinations) and other issues.<sup id=\"cite_ref-152\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-152\">[152]<\/a><\/sup><\/p>\n<h3><span id=\"Provider_discrimination\" class=\"mw-headline\">Provider discrimination<\/span><\/h3>\n<p>Provider\u00a0<a title=\"Discrimination\" href=\"https:\/\/en.wikipedia.org\/wiki\/Discrimination\">discrimination<\/a>\u00a0occurs when health care providers either unconsciously or consciously treat certain racial and ethnic patients differently from other patients. This may be due to stereotypes that providers may have towards ethnic\/racial groups. A March, 2000 study from Social Science &amp; Medicine suggests that doctors may be more likely to ascribe negative racial stereotypes to their minority patients.<sup id=\"cite_ref-153\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-153\">[153]<\/a><\/sup>\u00a0This may occur regardless of consideration for education, income, and personality characteristics. Two types of stereotypes may be involved,\u00a0<a title=\"Implicit stereotype\" href=\"https:\/\/en.wikipedia.org\/wiki\/Implicit_stereotype\">automatic stereotypes<\/a>\u00a0or goal modified stereotypes. Automated stereotyping is when stereotypes are automatically activated and influence judgments\/behaviors outside of consciousness.<sup id=\"cite_ref-Burgess_2006_119\u2013134_154-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Burgess_2006_119%E2%80%93134-154\">[154]<\/a><\/sup>\u00a0Goal modified stereotype is a more conscious process, done when specific needs of clinician arise (time constraints, filling in gaps in information needed) to make a complex decisions.<sup id=\"cite_ref-Burgess_2006_119\u2013134_154-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-Burgess_2006_119%E2%80%93134-154\">[154]<\/a><\/sup>\u00a0Physicians are unaware of their implicit biases.<sup id=\"cite_ref-155\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-155\">[155]<\/a><\/sup>\u00a0Some research suggests that ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.<sup id=\"cite_ref-156\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#cite_note-156\">[156]<\/a><\/sup><\/p>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-280\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Disparities in access to health care. <strong>Provided by<\/strong>: Wikimedia, inc. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#Problems_with_patient-provider_communication\">https:\/\/en.wikipedia.org\/wiki\/Health_equity#Problems_with_patient-provider_communication<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":142337,"menu_order":5,"template":"","meta":{"_candela_citation":"[{\"type\":\"pd\",\"description\":\"Disparities in access to health care\",\"author\":\"\",\"organization\":\"Wikimedia, inc\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Health_equity#Problems_with_patient-provider_communication\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-280","chapter","type-chapter","status-publish","hentry"],"part":99,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/280","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/users\/142337"}],"version-history":[{"count":1,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/280\/revisions"}],"predecessor-version":[{"id":281,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/280\/revisions\/281"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/parts\/99"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/280\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/media?parent=280"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapter-type?post=280"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/contributor?post=280"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/license?post=280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}