Health Insurance

disparity

A difference or inequality in outcomes or access, often unjust or avoidable.

health disparities

Differences in health outcomes across populations due to social, economic, or environmental disadvantages.

healthcare disparities

Inequities in access, quality, or availability of healthcare services among different groups.

access to care

The ability to obtain needed medical services, influenced by insurance coverage, geographic location, and affordability.

quality of care

The degree to which healthcare services improve desired health outcomes, often measured by safety, effectiveness, and patient-centeredness.

racial and ethnic disparities

Often driven by systemic racism, leading to lower coverage rates and poorer outcomes for minority groups.

socioeconomic disparities

Low-income individuals face higher uninsured rates and limited access to quality care.

geographic disparities

Rural areas may lack providers or hospitals, especially safety-net institutions.

gender disparities

Women may face higher premiums (e.g., for long-term care) and unique coverage needs.

age disparities

Older adults rely heavily on Medicare, but may face gaps in long-term care coverage.

increased risk of disease and injury

Impact of Disparities in health insurance: Delayed care and lack of preventive services heighten health risks.

decreased access to preventative care

Impact of Disparities in health insurance: Uninsured or underinsured individuals often skip screenings and checkups.

higher mortality rates

Impact of Disparities in health insurance: Poor access and quality contribute to worse outcomes, especially in marginalized communities.

lower quality of life

Impact of Disparities in health insurance: Chronic conditions go unmanaged, and financial strain from medical costs affects well-being.

systemic racism

factor contributing to disparities: Embedded in healthcare structures, affecting access and treatment.

structural inequality

factor contributing to disparities: Includes income gaps, housing instability, and education disparities.

individual level factors

factor contributing to disparities: Health literacy, employment status, and personal health behaviors.

expanding access to affordable health insurance

list the strategy to reduce disparities: Through Medicaid expansion and marketplace subsidies.

improving quality of care for underserved populations

list the strategy to reduce disparities: Via safety-net hospitals and culturally competent providers.

addressing social determinants of health

list the strategy to reduce disparities: Tackling housing, education, and food insecurity alongside medical care.

Medicaid

Joint federal-state program for low-income individuals; eligibility varies by state

Medicare

Federal program for people 65+ and younger individuals with disabilities; funded by payroll taxes

Employer-sponsored insurance

Coverage through employment; cost shared between employer and employee

individual insurance

Purchased directly or via marketplace; often more expensive and less comprehensive

how medicare and medicaid reduce disparities

• Provide coverage to vulnerable populations (elderly, disabled, low-income).

• Fund safety-net hospitals and essential services.

challenges the government faces

• Limited long-term care coverage (Medicare).

• State-by-state variation in Medicaid benefits.

• Funding constraints and administrative complexity.

effectiveness of medicaid and medicare

• Significant in reducing uninsured rates.

• Still gaps in equity, especially for long-term and mental health care.

Medicare

Covers hospital (Part A), medical (Part B), drugs (Part D), but limited long-term care.

Medicaid

Covers a wide range of services, including long-term custodial care.

Medicare

is federal and tied to work history

Medicaid

state-administered and income-based.

Disparities of Medicaid and Medicare

Individuals relying on these programs may face limited provider access, stigma, and bureaucratic hurdles.

Support for understanding medicaid and medicare

• Programs like CHIP and EPSDT for children, and SSI-linked Medicaid eligibility, help guide access.

• Case studies in the PDF highlight real-world challenges and reliance on these programs for survival.

skilled care

Provided by licensed professionals (e.g., nurses, therapists); includes rehab, wound care, and IV therapy. Covered under Medicare Part A for up to 100 days.

custodial care

Non-medical assistance with daily tasks (e.g., bathing, dressing); not covered by Medicare, but may be covered by Medicaid or long-term care insurance.

social security

A federal program established in 1935 to provide financial support for retirees, disabled individuals, and survivors.

social security eligibility

Based on work history and age; includes retirement (62+), disability (lasting >12 months), and survivor benefits (spouse, children, dependent parents).

retirement benefits

List the type of social security benefit: Monthly payments based on lifetime earnings.

disability benefits

List the type of social security benefit: For individuals unable to work due to long-term disability.

survivor benefits

List the type of social security benefit: Support for family members of deceased workers.

SSI (Supplemental Security Income)

List the type of social security benefit: For low-income elderly or disabled individuals.

CHIP (Children’s Health Insurance Program)

Title XXI of the Social Security Act; provides low-cost health coverage to children in families earning too much for Medicaid.

CHIP eligibility

Varies by state; generally for uninsured children under 19.

Medicaid Expansion CHIP

Offers full Medicaid benefits including EPSDT

Separate CHIP programs

Cover well-child visits, immunizations, prescriptions, dental, vision, emergency services.

safety net hospitals

Serve high numbers of low-income, uninsured, and medically vulnerable patients. Crucial for reducing disparities and providing essential care.

challenges of safety net hospitals

• Underfunding

• High demand from underserved populations

• Rising costs and uninsured rates

• Financial strain threatens sustainability

funding sources of safety net hospitals

• Government subsidies (Medicaid, Medicare)

• Philanthropy and grants

• Public programs like CHIP

support resources of safety net hospitals

• Federal and state funding

• Community partnerships

• Nonprofit organizations

• Advocacy for policy reform

For-Profit Hospitals

Owned by investors or corporations; aim to generate profits for shareholders.

chain hospitals

List the type of for profit hospital: Operate under corporate systems.

physician-owned hospitals

List the type of for profit hospital: Run by medical professionals with financial stakes.

financial incentives of for profit hospitals

• Profit-driven decisions

• Focus on high-revenue services

• May prioritize insured or higher-income patients

benefits of for profit hospitals

Efficient operations, access to capital, innovation

drawbacks of for profit hospitals

May limit access for low-income patients, widen disparities

impact of for profit hospitals on costs and quality

• Can drive up healthcare costs

• Quality may vary based on profit motives

• Less likely to provide charity care

non-profit hospitals

Operate without profit motive; reinvest surplus into services and community programs.

religious hospitals

list the type of non-profit hospital: Often affiliated with faith-based organizations.

community hospitals

list the type of non-profit hospital: serve local populations with broad services

financial incentives of nonprofit hospitals

• Tax exemptions

• Donations and grants

• Community support

benefits of nonprofit hospitals

Focus on community health, charity care, lower-cost financing

drawbacks of nonprofit hospitals

May face funding challenges, less capital access

impact of nonprofit hospitals on costs and quality

• Often provide high-quality care

• More likely to serve diverse populations

• Help reduce disparities through outreach and preventive services