1 9. Social and Economic Inequalities: Health Learning Intentions (Pupils should be able to): 1.Explain the US system of health care and describe its effectiveness. 2. Provide evidence of inequality in terms of health and health care in US society. The system of health care in the US is very different from the UK. In the USA there is no national health care provision. Instead there are a variety of Federal Govt. or State-supported health programmes which give assistance to old people, poor people 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. Health care provision is a contentious issue.

2 Social and Economic Inequalities: Health Most Americans (58%) receive their private health insurance through their employer. Companies like BlueCross BlueShield are among the leading private health care providers. US Government health programmes cover around 28% of the population (83m 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 the disabled. Administered by States. State Children’s Health Insurance Program – Covers those children who do not qualify for Medicaid. Around 45m (15% of population) Americans have no private health insurance and do not qualify for Medicaid.

3 Problems with the US health care system (pre-2010) The US health care system works well for those with full- coverage private medical insurance. Facilities and treatment can be world class, public satisfaction rates are high and waiting times are virtually non-existent. However… the USA spends the most money on health care in the world ($2.26 trillion; 15.2% GDP) but outcomes (life expectancy, infant mortality, etc.) are poorer than many other developed countries. there is a great deal of duplication/inefficiency in the US health care system as companies compete for business. Also, bureaucracy (paper work) costs are high. the system is hugely unfair. 1.5m Americans lose their home every year due to unaffordable medical costs. there are few incentives to promote health education.

4 Social and Economic Inequalities: Health Impact of US health care system on minority groups As Blacks and Hispanics are more likely to have lower incomes or to be unemployed, they are, as a result, less likely to have private medical insurance. They are also more likely to depend on Medicare or be uninsured. 50% of Blacks and 42% of Hispanics have private health insurance compared to 74% of Whites. 21% of Blacks and 32% of Hispanics were uninsured compared to only 13% of Whites and 14% of Asians.

5 Social and Economic Inequalities: Health Overall Health Ethnic minorities suffer worse health compared to whites. Black women have the highest death rates from heart disease, lung cancer and strokes. Hispanics are more likely to be employed in high-risk occupations. Infant mortality is twice as high for Black infants as it is for white infants.

6 Social and Economic Inequalities: Health Selected health statistics by ethnic group Life expectancy (years) 2009 WhitesBlacksHispanicsAsians Native Amer Infant mortality rates (per 1,000 live births) 2009 WhitesBlacksHispanicsAsians Native Amer Percentage of Americans by ethnicity not registered with a doctor WhitesBlacksHispanicsAsians Native Amer

7 Questions 1. Slide 2. Describe the ways in which Americans obtain health care. 2.Slide 3. “The American health care system works well.” Ross Shannon. To what extent is Ross selective in his use of facts? 3. Slide 4. What evidence is there of ethnic inequality in access to US health care. Make two points. 4. Slide 5. What evidence is there of ethnic inequality in health in the USA. Make three points. 5.Read the BBC News article attached. Click here for link.Click here for link. Reading: Pulse: ‘International Issues’ pages 70, 73 and 75 or Leckie and Leckie: ‘Course Notes’ pages Social and Economic Inequalities: Health