Healthcare equity in the United States means giving everyone an equal opportunity to be healthy. Achieving this in practice will involve a huge commitment from the government and a range of national programs. US residents need care that is accessible, affordable and adequate for their needs. Community healthcare schemes are at the vanguard of health equity, but better financial assistance and innovative ideas can help other services to break down barriers. From transport to housing and economics, new strategies need to take into account the specific needs of a neighborhood and how to mitigate the problems they experience.
Giving everyone equal access to care sounds like a straightforward and common sense plan, but in practice, many factors can influence a person’s experience of healthcare. Having a safe place to live, a job and an education are all important, so is eating healthy food, living without discrimination, and having access to care. For many, gaining access to care is one of the biggest challenges, especially if people are living rurally and have no transport. People also need some form of health insurance, as well as time off work to receive treatment and maybe a translator, if their first language is not English.
According to ECRI — a large non-profit which seeks to improve patient safety — shortages of staff can also impact health equity. A shortage of nurses and physicians has created longer waiting times and can even result in patients being turned away from hospitals.
Choosing to be a nurse takes a high level of commitment, but those who put in the work will be rewarded with an incredible career. People who want to make a difference can apply for an online accelerated BSN program and qualify as a nurse within 15 months. At the University of Indianapolis, there are two residencies that build students' confidence in a simulated medical setting and a clinical placement where they gain real-world experience.
Across the USA several initiatives are improving access to healthcare. Here is a look at some of the most successful services which support health equity:
Community services such as health centers understand the people they are serving and their specific needs. Community-based solutions are considered one of the key routes to healthcare equity. Since 1965, when these centers were considered experimental, they have brought care to underserved neighborhoods and communities, both urban and rural. These centers dispense primary care for patients with conditions that affect their mental and physical health. Preventative medicine is also part of the offering. Thus, patients are less likely to need complex treatments in the future.
After the Affordable Care Act (ACA) in 2014, the geographical areas covered by community health centers expanded. They treat over 30 million patients of all ages. In fact, they can even bring mobile dental and medical services to the remotest of communities. Centers are funded through the federal Public Health Service (PHS). Some patients may have private medical insurance, while others have Medicaid. People who are uninsured or have a condition that is not covered by their policy will be charged on a sliding scale. This takes into account their income and the number of people in their household.
During the COVID-19 crisis, hospitals needed to treat patients with non-life-threatening conditions without seeing them in person. As a result, telehealth — a service that had been available for some time — was used to triage, diagnose and treat patients. Now the pandemic has largely passed, the benefits it offers are directly transferable to supporting health equity. Wherever patients are in the country they can contact a health professional or care service from the comfort of their home. It is also useful for people living in poorer communities who cannot afford to travel in order to receive care. Or, for elderly patients who may be unable to leave home. In some regions, telehealth is being combined with mobile medical assistants (MAs). These assistants visit people at home and build on the work already done by the telemedicine team.
There is a significant shortage of mental health services in the US. This is also happening at a time when growing numbers of people are needing help. As they cannot afford private care, it is often people in low-income communities who suffer the most. This can lead to people living with an untreated condition and not receiving help for years. In 2021, the American Rescue Plan Act (ARPA) set aside money to support services dealing with the problem. Some of the most effective have been school-based mental health clinics. These link children, their family, and their school with effective mental health services. In most of these clinics, appointments can be made by students themselves. Thanks to the ARPA funding, wait times are also often low.
According to The Immigrant Learning Centre: “…immigrants have limited access to health care, particularly government-funded health care.” This is partly to do with visas. However, cost and the language barrier can hold people back from attending hospital when they need to. In various parts of the country, there are services that aim to mitigate the barriers to healthcare access that immigrants can experience.
Encompassing free screening services that provide early detection for a range of serious conditions with health education, the HPES already helps numerous people in St. Louis. However, their service is now branching out to serve immigrants who face obstacles when attempting to access care. They do this by hosting screening events in locations that are easily reachable. For example, local libraries and churches.
Services that work to target several barriers to health equity at the same time are often the most successful. Especially, as many of these issues are interlinked. As local services and community care initiatives make strides to reduce inequities, larger national programs can follow their lead.
