Race and age matter

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HCA 4303, Comparative Health Systems 1

Course Learning Outcomes for Unit I

Upon completion of this unit, students should be able to:

1. Identify and explain how demographics, such as age and race, impact true access to quality care.

Reading Assignment

Chapter 1: Introduction

Chapter 2: Disparities in Health Care: Race and Age Matters

Unit Lesson

Many Americans find it difficult to even comprehend being denied access to medical care. When we are sick,
we want to see a physician, promptly receive a diagnosis, and procure the necessary treatment that will
restore us to our previous level of health. The concept of waiting for several days to see a physician or not
receiving the care we believe we need seems barbaric at best. Yet, people all over the world face this reality
every day, and the possibility of that happening in the United States is more real today than any time since
the reorganization of medicine in the 1930s following the Great Depression.

Lovett-Scott and Prather (2014) define true access as more than healthcare services being made available.
They include three additional qualifications: 1) being able to get to and from services (transportation), 2)
having the ability to pay for the services, and 3) getting your needs met by the service. This definition builds
upon your previous learning and is appropriate for most any healthcare setting. Most healthcare
administrators spend a large portion of their day determining access to care and problem-solving issues and
obstacles to receiving adequate health care. One place where this is pivotal is in the appointment line. This is
where patients call to schedule an appointment. Although we would like to provide everyone an appointment
within 24 hours of their request, it is virtually impossible in most settings.

This has often resulted in a costly overuse of Emergency Departments (ED) to handle routine care, which
drives up the overall cost of health care. There is no similar solution for access to specialty and subspecialty
care. When someone is referred by their primary care provider to see a pediatric neuropsychiatrist, they are
not likely to find any shortcuts to appointments. The same could be said for numerous elective surgeries.
These types of resource shortages and waiting lists have prompted many influential individuals with financial
resources to become “medical tourists” in order to purchase the care outside of the United States that they
need or desire without the same restrictions found in the United States.

In this class, we will discuss the healthcare delivery system in both developing and developed countries
around the world using a comparative analysis to better understand the benefits and detriments they provide
to those they serve. Although we often think of medicine as being a sacred, altruistic calling managed by the
most caring of all human beings, it is also a business that must be maintained by following a business model.

Regardless of who is paying for the services, there is a cost and a need to regulate as well as ration
resources. Each day, healthcare leaders balance several interlocking variables such as the amount of
resources available and the needs of the people requiring health care, and they serve as a “gatekeeper” for
those services. Whenever possible, nurses, advanced practice nurses (nurse practitioners), physician
assistants, and other mid-level providers are used as “physician extenders” in an effort to improve access to
care. The delivery system in countries around the world are designed to balance supply and demand.
However, as we will see in this unit, demographics also play a key role in allocating medical resources.


Access to Care–Lack of Access
to Care: Perception, or Reality?

HCA 4303, Comparative Health Systems 2



Another word to describe these differences and inequities related to basic demographics, such as gender,
race, ethnicity, geographical location, income, and socioeconomic status (as opposed to clinical resources for
appropriate care) is disparities. Lovett-Scott and Prather (2014) use numerous real-life examples to discuss
the multiple causes and interdisciplinary approach needed to rectify disparities inside and outside of the
United States. You will perhaps find many of the examples appalling or even impossible. Yet, they do exist.
Their perspective provides a much-needed reexamination of the status of health care today.

In Units II-VIII, we will focus on the eight major factors that determine a country’s true access to care based
on the original work of Lovett-Scott and Prather (2014). We will spend the majority of our time doing
comparative analysis; two factors and two countries at a time. In Unit III, we will explore Eastern and Western
medicine approaches by examining the United States and Japan through the lenses of historical approach to
health care and the current structure each country employs to deliver the care. Similarly, in Unit IV, we will
compare India and Canada on their healthcare financing strategies and their views on when to intervene in
the health needs of their people (primary care, acute care, or emergency care).

In Unit V, we will compare the United Kingdom and Ghana in their approaches to preventive health care and
use of available resources. We will compare the major health issues and disparities in both France and Cuba
in Unit VI. In Unit VII, we will focus on the behavioral health (formerly mental health) issues found in both
developing and developed countries. Finally, in Unit VIII, we will apply the knowledge gained to examine your
personal and professional vision for providing true access to quality health care. It will be helpful if you keep a
“good idea” journal during this course to write down ideas you may have or interesting facts you are learning
so you can write a final paper describing how the information in the course has shaped your thoughts on
healthcare delivery and disparities.

As leaders in the healthcare industry, the burden falls on each of us to become sensitive to the ongoing needs
of people from a variety of cultures, to embrace diversity, and to end disparities whenever possible. As the
authors say, it is time to move the discussions about disparities from the boardroom to a position of action.
Understanding and managing the expectations for access to care and mitigating disparities for various
cultures will continue to be a significant core competency of healthcare administrators.

Learning Activities (Nongraded)

Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit
them. If you have questions, contact your instructor for further guidance and information.

Use this Note-Taking Guide as you read Chapter 1 and 2. (Key Available Below)

1. __________ health is, in some countries, the overarching umbrella under which community-based

psychiatric mental health services are often grouped.

2. The National Institute of Health (NIH) defines behavioral health as __________ __________ to

underlying motivation.

3. The healthcare system in the United States is primarily __________ __________ financed and


4. The Eight Factor Model derives from __________ __________ with consumers and healthcare


5. Much of the world’s population is dying from __________ and __________ that are well within the

realm of prevention:

6. Being in sync with every patient’s health __________ and __________ is no easy task but required if

a provider is to address true access to care.

7. __________ discussions typically evoke strong emotions and should be carefully planned.

8. We must talk __________ rather than __________ the patient.

9. It has been well established that often people of __________ __________ will not go on

antihypertensive medications.

10. A problem of particular concern that results in disparities is that some clients lack the ability to pay for


HCA 4303, Comparative Health Systems 3



Fill in the Blanks Answer Key


Answer Location of the
Answer in the


1. Behavioral p. 9

2. Overt

p. 9

3. private

p. 4

4. extensive

p. 7

5. illnesses

p. 15

6. need,

p. 18

7. Diversity

p. 22

8. to, about p. 8

9. African

p. 20

10. medications p. 19

Key Terms

1. Access
2. Developed countries
3. Developing countries
4. Disparities

1.Write an essay discussing the various causes and solutions for a patient’s inability to pay for medications (prescriptions).

Your response should be at least 200 words in length

2. “Front desk syndrome” is a particularly troublesome aspect of patients visiting their healthcare provider. Write an essay describing this phenomena and methods to prevent or decrease its occurrence.

Your response should be at least 200 words in length.


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