Spotlight Exclusives

Proven Policies to Reduce Health Disparities among the Poor

Barbara Wolfe, University of Wisconsin-Madison Barbara Wolfe, University of Wisconsin-Madison, posted on

Those living in poverty suffer significantly worse health outcomes than wealthier Americans. The causes of these disparities are multifaceted, but the lack of access to quality medical care stands as one of the clearest challenges. And while the U.S. already has a number of programs in place designed to expand access to health care for poor and low-income Americans, much work remains to be done.

The disparities in access to health insurance and medical care are striking. The 2014 Current Population Survey revealed that 24.9 percent of poor Americans lacked health insurance while only 7.5 percent of those above twice the poverty line were without coverage. And the 2014 National Health Interview Survey data reveals that the poor were 4.3 time more likely to delay or forgo medical care than those with incomes greater than 400 percent of the poverty line. Even larger differences exist for access to dental care.

Since the launch of the War on Poverty over fifty years ago, numerous programs and policies have been implemented to increase access to medical care for poorer Americans. The largest of these efforts is Medicaid, which is supplemented by the Children۪s Health Insurance Program (CHIP) to help low-income families who do not qualify. Together these policies cover around 70.5 million people, a number that has risen dramatically due to the implementation of the Affordable Care Act.

Additionally,community health centers provide primary and preventive health care to populations with limited access to care and in 2013 served 22 million patients, 72 percent of whom were at or below the poverty line.

Finally,the National Health Service Corps (NHSC) aims to increase the availability of medical personnel to “medically underserved areas.” It offers financial assistance to medical school students and others in exchange for service in underserved areas and has more than 10,000 clinicians involved.

Despite this extensive array of programs, however, major disparities in health and access to health care remain. But there are ways to reduce the gaps.

While health insurance is critical, public discussions often overlook the importance of efforts like the NHSC. Even if everyone were to be insured, access would still be limited by the supply of health care providers.

In addition to expanding the NHSC, we should increase the supply of “medical extenders,” such as nurse practitioners and physician assistants, train them to practice independently, and push to modify the scope of practice laws to permit such practice. Studiesfind that the quality of care provided by nurse practitioners is actually higher than that of MDs in primary care settings.

States also should facilitate the training and use of primary care technicians, who would be trained to care for persons with certain chronic diseases and provide basic preventive care, practicing under the guidance of MDs or NPs. PCTs could be individuals from the community with a high school or associate degree.

Finally,building more community health centers is another way to expand access to care.The best evidence shows that these centers can have a substantial impact, with a recent paper finding they decreased the poor-to-non poor mortality gap for those age 50 and up by 25 percent.

We should work to establish a community health care center in all large,underserved and poor urban areas, ensuring it is within walking distance of the majority of residents. Centers will be more successful if they offer childcare, a pharmacy, and specialist services as well.

The key idea behind all of these suggestions is to make access local and increase the supply of primary care providers so the poor do not have long delays in obtaining care. By scaling back or eliminating ineffective programs such as unsuccessful enrollment outreach efforts and Medicare support for training of many specialists, we can ensure adequate funding is going to the priorities outlined above.

Eliminating the health disparities that exist in our country is no easy task, but we already have a solid foundation of programs and evidence to build upon. By expanding what works and exploring new efforts, we can build a healthier and more equitable society.

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Barbara Wolfe is Richard A. Easterlin Professor of Public Affairs, Economics, and Population Health Sciences and a faculty affiliate of the Institute for Research on Poverty at the University of WisconsinMadison.  

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