In the biomedical model of health, access to health care leads to improved health. The “logical” assumption then follows that universal health insurance would lead to equal access to these services and thus improved overall health. As we get closer to October 1st, when the state health exchanges will open, we must ask ourselves if this assumption is true. When we get to universal or near universal health care coverage, will health disparities decrease?
Why Won’t Universal Health Coverage Significantly Reduce Disparities?
The reasons for health inequities are complex. They include determinants of health such as income, education, socioeconomic status, discrimination, housing, environment, food security, social support, transportation, and working conditions.,,, Moreover, sources of disparities exist even within the healthcare system, as evidenced by the Institute of Medicine (IOM) report, “Unequal Treatment.” This report found approximately 175 studies documenting racial/ethnic disparities in the diagnosis and treatment of various conditions that persisted even after controlling for possible confounders. Thus, even universal access to health care does not guarantee universal equal treatment.
Evidence indicates that with universal medical care coverage health disparities would likely improve for certain sub-populations (such as individuals with HIV and children) who are particularly vulnerable and responsive to changes in availability of medical care. Additionally, health insurance can positively affect control of high blood pressure for adults, especially those in low-income groups., Still, questions remain about how effective health insurance can be for other groups and which aspects of medical care deserve more investment versus social infrastructure programs.