The U.S. has one of the world's largest health disparities between the rich and poor — behind only Chile and Portugal — and its healthcare system and lack of social supports are to blame, experts say.
Researchers examining surveys on health and income from people in 32 countries found poor Americans reported worse health than rich U.S. residents in significant numbers. Of the poorest third of Americans surveyed, 38.2% reported “fair or poor health” compared to just 12.3% of the richest third, leaving the U.S. in the bottom three of the nations examined, according to the Harvard study, published in the June issue of Health Affairs.
The gap is caused by several factors, including the high number of uninsured in the country, particularly before the implementation of the Affordable Care Act, said Joachim O. Hero, the study's lead author.
“There are much higher out-of-pocket costs per person in the U.S. than you typically see in other places and the way those out-of-pocket costs are distributed is less equitable, so people who are poor are less able to afford health insurance that is generous," said Hero, who recently completed his health policy doctorate at Harvard University.
As a result, “they tend to be more exposed to the high costs of the U.S. healthcare system,” he said.
But that’s not the whole picture.
Elizabeth H. Bradley, a professor of public health at Yale and the faculty director of the Yale Global Health Leadership Institute who was not involved in the study, said another issue may be society itself. The U.S. provides fewer social safety nets — that is, services and programs that help prevent people from falling into poverty — than many other countries, she said.
“When we look at other high-income countries and see how much of the GDP these different countries spend on things like income support, housing, nutrition . . . the U.S. is much lower," she said.
The study also showed that although most of the Americans surveyed believed “many” people in the U.S. do not have access to the health care they need, they showed less concern about the discrepancy than those in other countries.
There are two schools of thought on why: the lack of concern may have caused the health care system's inequities or Americans have simply become accustomed to it.
“It’s probably a bit of both,” Hero said.
Although the surveys were conducted before the implementation of the Affordable Care Act (ACA), the findings may be especially significant now. The U.S. House of Representatives last month passed a version of the American Health Care Act, which would undo many ACA provisions if the Senate also approves the bill.
The Congressional Budget Office predicted 23 million Americans would lose insurance under the House-passed bill.
“There is a relevance to looking back at where the U.S. stood right before the reforms of the ACA ... to give us a sense of where the U.S. was,” Hero said.
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