Health insurance and the ongoing debate of quality and quantity

Health disparities are differences in health among different groups of people. Generally related to socioeconomic factors, they culminate in differential outcomes among people suffering from similar conditions. Health disparities span all of health care—from management of chronic conditions (hypertension) to more acute conditions (cancer). An often-cited result is a widening gap in life expectancy between groups. Beyond survival, health disparities have a profound impact on general well-being. Multiple factors contribute to health disparities, including income inequality, which has increased dramatically and has been associated with a widening gap in life expectancy.¹ Wealthier individuals have greater flexibility when considering options. The relationship between health care outcomes and income is likely more complicated than available monetary resources. Education has consistently correlated with health outcomes. New technology created a demand for skilled labor demanding higher wages while simultaneously decreasing demand for less skilled labor. Better jobs afforded by advanced education provide access to higher quality insurance. Education (in conjunction with financial potential) may increase access to and adaptation of healthful behaviors—smoking cessation, weight loss, etc—and improves compliance with complex therapies. Rising income inequalities promote geographic segregation of high- and low-income populations, resulting in differential diffusion of positive and negative influences. Health care access and type of insurance are other determinants of disparities. The article by Brown et al in this issue reports that the type of insurance correlates with treatment and outcome in glioblastoma patients.²