In August, US News and World Report released its 2016-2017 ranking of America’s best hospitals, and as usual, the list of the top twenty contains only private or teaching hospitals located in major cities or suburbs. Not one of the hospitals is wholly government-operated or located in a rural area. Indeed, the 2016-2017 US News hospital rankings illuminate one of the greatest problems in healthcare and public health both in the United States and internationally, a problem that neither of the presidential candidates has spent much time discussing: health disparities.
To be able to understand the issues we face domestically, it is often beneficial to go abroad. I was located in Lima, Peru for two months this summer as part of a team from Johns Hopkins University studying chronic obstructive pulmonary disease (COPD), a long-term lung affliction most commonly associated with smoking. During my time in Lima, I observed great disparities in healthcare in the country that crystallized the issues we face in the US.
In one public clinic that I visited, located in one of the poorest areas of Lima, stray dogs sat next to patients in the waiting room, and basic sanitation was essentially nonexistent. Meanwhile, in downtown, the private hospital I visited with its well-dressed receptionists and spacious examination rooms reminded me of some of the best hospitals in America. Through meetings with physicians and patients, I learned about how healthcare disparities are omnipresent in Peru. Studies show significantly worse health outcomes, such as infant mortality and disease rates, in poorer areas in Peru. Peruvians who earn less than a certain income are guaranteed health insurance, but that insurance only permits citizens to access public clinics and hospitals, which feature much lower quality of care than private hospitals.
Physicians in Peruvian public hospitals told me that they have significantly less time to see patients than their counterparts in the private hospitals. Uncleanliness and a lack of sterility in operating rooms were a common problem that I observed in public hospitals as well. Furthermore, as relates specifically to COPD, Peruvian public insurance only funds three different medications for the disease, compared to private insurance which funds dozens of potential medications and allows physicians to mix and match medicines to find the perfect combination to treat patients.
Although Peru, where the annual health expenditure of $359 is 1/26 that of the US, likely has greater absolute health disparities than America, my experiences in Peru reminded me of how America too is confronted with large gaps between how different demographic groups experience healthcare. The city of Baltimore, where Freddie Gray died in a trauma center in 2015 after a confrontation with police, is an excellent example of healthcare disparities in America. According to the Baltimore City Health Department, residents in the northern part of the city can expect to live up to 19.3 years longer on average than their counterparts in neighborhoods such as Sandtown-Winchester, where Gray once lived. The nonprofit Kaiser Family Foundation has published statistics that demonstrate that in modern America, race and socioeconomic status continue to be major determinants of the quality of healthcare received.
To address the health care disparities that America faces, I learned during my experiences in Peru that it is not enough to merely offer health insurance to all citizens. Even the poorest Peruvians can acquire health insurance, but doing so does not grant them high-quality healthcare. Similarly, while universal health insurance in America would be a positive first step to begin to mitigate healthcare disparities, insurance is not enough on its own.
Despite its inequalities, one positive aspect of Peru’s health care system is that all physicians who seek employment in a public hospital must first work in a rural clinic. US medical schools and teaching hospitals could implement a similar requirement, in which physicians-in-training must work with the under-served for a certain time period. First, however, it is important to just gain awareness of the issue of health disparities and to have a national discussion about them. Peru and the United States are very different in regards to the state of their economic development, but the health care disparities that I have observed in both countries are more similar than one would expect. In our quest for a more egalitarian country and world, addressing health disparities would be a bold first step forward.
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