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Healthcare Disparities

The provision of healthcare is no doubt one that has proven a challenge for most countries to provide. The model employed by different countries usually differs from time to time, with the different variations in the approaches to healthcare leading to a variety of results. In most cases however, a number of citizens usually end up complaining over the disparities that may arise as a result of the approaches adopted by the government of the particular country. One country that is of interest, is no doubt The Peoples Republic of China, which utilizes an interesting approach to the provision of healthcare, and as a result, has experienced a number of challenges in ensuring universal healthcare for all. The problem is however, not unique to China, as disparities are also experienced in other countries such as the United States, despite the differences in approach.

Irene Su, in the article “A Dream Yet to Come True: Disparity of Healthcare Access in China,” describes the approach to healthcare adopted in China, as well as the numerous disparities that still exist in the country. Su begins by describing the shift in China, from a closed door society to a market economy. A change she argues has had a positive effect on the country’s economy, as it has essentially led to economic success, although the healthcare system remains “seriously deficient (Su, 2007). According to Su, prior to reforms to a market economy, the country’s healthcare system was primarily funded by the government, and took a shape similar to a socialized medicine system, which was free or came at very little cost to the general public. This led to a highly efficient system characterized by an increased life span and decreased mortality rates, as well as a highly successful preventive program. However, following privatization and increased liberalization, government funding for healthcare reduced drastically, to a point that a WHO report as cited by Su (2007) indicated that the cost f healthcare in 2005 had rocketed to 40 times what it was in 1978. A recent survey reported by Su, showed that 44.8% of urban residents essentially lacked insurance coverage, while 79.1% of the population in rural areas found themselves having to pay for medical expenses from their pockets. Overall, a staggering three quarters of the population did not have access to any form of government funding, leading to poor health seeking behaviors. The available health insurance schemes have led to significant disparities, as most of them seemingly favor the urban population, while significantly putting the rural population at a huge disadvantage. Out of the four available insurance schemes (labor health insurance, government employee health insurance, private insurance, and rural cooperative medical system) only one targets the rural population, and is hugely underfunded as it depends on the decentralized fiscal system. This lack of insurance is further exacerbated by the lack of quality healthcare institutions, partly due to the significant bureaucratic barriers to operating private hospitals, as well as the discriminatory nature with which government funding is distributed. The net result, according to Su (2007) has been a system that is incapable of satisfying neither the rich, nor the poor, as the former essentially complains about poor services, while the latter uis hardly able to afford the most basic of services.

The main cause behind the healthcare disparities and poor services, is the decreased government funding, as well as the decentralized approach to funding. By leaving healthcare funding to local authorities, the government is essentially creating room for massive disparities in healthcare provision, as the local authorities located in rural areas definitely cannot compete with their counterparts in the urban centers. Considering the income disparities between the rural and the urban population, this re3presents a major handicap, as most of the rural population is already unable to support its own medical expenditure. Further, the insurance schemes available, favor the urban areas, including the one provided by the government, as they mostly target the population in formal employment, essentially locking out casual laborers and farmers. This therefore means that a majority of the rural population are left to their own devices, while rural to urban migration remains on the rise, hence raising the number of members of the urban population without proper medical cover. In addition to the poor approach to provision of healthcare, the differences in socioeconomic status also contribute significantly to the disparities in healthcare access. Obviously the ability of members of the high class of society is not similar to that of individuals in the lower class, and the fact that disparities in the earnings of the citizens continue to widen is an indicator that inequalities continue to exist in China despite economic reforms. Measures such as the banning of rural to urban migration only served to deepen the crisis and widen the gap between the rich and the poor. On the other hand massive rural to urban migration continues to deprive the rural areas of much needed skilled manpower, leading to imbalanced development.

The problem is however not unique to the Peoples Republic of China, as a number of countries struggle to find the right balance between supporting a free market in the provision of healthcare, and subsidizing healthcare to ensure access for all. For instance, in the United States, healthcare disparities still exist, despite the existence of some of the best facilities and freely available medical technology. In addition, the United States healthcare expenditure ranks as the highest in the world, which leads to questions over why the system still remains skewed in favor of a select few. Unlike in China, public medical insurance schemes such as Medicaid and Medicare do not discriminate based on mode of employment, although the latter mainly covers individuals aged 65 and over. Instead, it attempts to provide medical insurance to all. Although a majority of the population is usually covered by employer sponsored medical insurance, about 5 percent are covered by private insurers. Despite these advances in technology and significant government funding, racial minorities still experience higher morbidity and mortality rates compared to their white counterparts. These disparities reflect a pattern of racial inequality, as the minority groups make up the majority of the uninsured members of society. This is a manifestation of a deeper lying problem, that dates back over 200 years: that of racial discrimination and historical injustices committed against the minorities.

There is no denying that the white population is significantly more empowered economically compared to their Latino, Asian, and African American counterparts. These disparities are also observable in the education sector, where African Americans rank as the worst performing race. Similar to China, this has led to a continued perpetuation of historical disparities, in the sense that the rich continue to get richer, while the poor continue to wallow in a vicious cycle of poverty. Access to healthcare, despite the government’s best efforts, continues to remain linked to economic status. Although various not for profit organizations are rising to bridge the gap between the rich and the poor when it comes to healthcare provision, the underlying problem is much bigger than just healthcare provision. In order to effectively eradicate the healthcare disparities, the government must put in significant effort to first eradicate the racial inequality that still exists. Although affirmative action continues to be implemented, more effort needs to be put in. The affirmative action should be extended to other areas such as employment and career advancement. Through empowering the minorities financially, the government will be able to eradicate the healthcare disparities that exist in the United States.

For the Peoples Republic of China, government funding must improve, in order for the numerous disparities to be eradicated, more so funding for the rural areas. The government needs to assist local authorities in those areas fund their medical programmes, in order to help bridge the gap between them and their urban counterparts. Further, development and employment opportunities need to be provided in the rural areas, in order to aid in their development and strengthen them financially, hence eradicate chances of rural to urban migration occurring. This would serve to improve the ability of the local populations to afford medical care, hence improve healthcare access.

Works Cited

Su, Irene. A Dream Yet to Come True: Disparity of Healthcare Access in China. Topics inAdvanced Practice Nursing eJournal, 7.3, 2007. Web.