Large gap in perceptions of health and healthcare between rich and poor in U.S.

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The difference between perceptions of the healthcare system among high-income and low-income Americans is greater than in most other countries, per a new study.

The difference in how high- and low-income individuals see health and healthcare in the United States is larger than in most other countries, per a new study.

Writing in Health Affairs, Joachim O. Hero, a doctoral candidate in health policy, Alan M. Zaslavsky, Ph.D., and Robert J. Blendon, all of Harvard University, described their examination of income gaps in 32 middle- and high-income countries between 2011 and 2013. They reported that the difference between high-income and low-income Americans when it comes to their history with the healthcare system and their confidence in continuing access to care proved to be among the highest in any country they surveyed.

The widespread presence of healthcare inequality in the United States is neither a new topic nor an unknown one—parts of the Affordable Care Act (ACA) targeted the problem directly, reducing the number of uninsured poor Americans from roughly 25% in 2015 to 7.6% in 2017, per previous reporting by FierceHealthcare.

The study found “relatively low levels of moral discomfort” regarding healthcare disparities compared to other countries, though over half the respondents in the United States indicated such inequalities were unfair. Moreover, the study found that “those respondents were significantly more likely than their compatriots to support major health system reform.”

Other evidence of this gap may appear in the political division over the healthcare system, according to the authors. The current effort to roll back provisions of the ACA via the American Health Care Act could further exacerbate inequities in the healthcare system, per the report.

The study identified several areas in which the ACA contributed to reductions in disparities, including reduced rates of uninsured individuals, as well as direct research and support for programs designed to close the gap between healthcare experiences for the rich and the poor.

“Eliminating these efforts without providing clear alternatives would risk taking a step backward in an area where the United States is in sore need of improvement,” the report warned.