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Improving Access to Health Care Through
Physician Workforce Reform - Continued, 3rd Report

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Poor and/or Unequal Health Status Within the Population

Many socioeconomic factors affect health status, including poverty, unemployment, lack of education, poor housing, and unsafe neighborhoods. Figure 1 displays indicators of health status and medical care utilization by race and poverty status. This information provides evidence that the health status of individuals in the population varies according to race and socioeconomic status. Simply stated, our Nation's most vulnerable citizens - minorities, the poor, the unemployed, and the poorly educated - are at greatest risk for poor health.

However, health problems are exacerbated by barriers to regular primary and preventive care. Unfortunately, our Nation's most vulnerable citizens are also the mostly likely to be uninsured. Although Medicaid is often considered to be the catchall program for the poor, in reality, this is not the case. At the time it was enacted as Title XIX of the Social Security Act in 1965, Medicaid was not intended to pay for medical services of all poor Americans. Instead it was designed to provide medical assistance to those in the welfare program categories of the aged, blind and disabled, and poor women or families with children thus leaving out poverty-stricken single people and childless couples. The restricted financial criteria for Medicaid eligibility have excluded the employed poor. For reasons that include these limitations on eligibility, about 60 percent of the poor do not receive Medicaid benefits. This leaves a significant gap between the number of people living below the poverty level and the actual number of Medicaid recipients. Consequently, substantial numbers of individuals do not benefit from any health program coverage for major portions of the year. The resulting lack of health care is associated with worse health status among the poor.

International comparisons also provide much ammunition for critics of the U. S. health care system. The United States fares poorly as compared with other developed countries in several major health indices:

• In 1988, the United States ranked 23rd out of 40 selected countries in terms of infant mortality (see figure 2 for U.S. comparison of infant mortality among five selected countries belonging to the Organization for Economic Cooperation and Development [OECD]).

• The United States ranks in the bottom half among the OECD countries in terms of male and female life expectancy at birth. (Figure 3)

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