A number of studies have documented evidence on the existence of racial disparities in accessing healthcare insurance. Minority races such as African Americans, Hispanics, and Caucasians have less access to healthcare insurance in comparison with their Caucasian counterparts (Cook, 2006). Lack of health insurance among the black population can be attributed to a number of factors, including lack of adequate income to finance medical treatment and bills, lack of healthcare facilities, and unemployment, among others. As the number of unemployed individuals in South Carolina increases, there is also a resultant increase in the number of people without health care insurance. Over the last decade, there has been a dramatic increase in the number of uninsured African-American men and women. For example, the number stood at 6.3 million in 2000, but by 2004, it had increased drastically to 7.2 million (Families USA, 2006, p. 1).
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When blacks do not have access to adequate health care, this places them at an increased risk of getting chronic and acute illnesses. However, improving access to health care would go a long way towards enhancing the health status and overall wellbeing of the black community. When an individual lacks health insurance, what this means is that he/she will find it increasingly harder to access the right health screening and preventive procedures. Increasing access to health care services among the black community, what this means is that it becomes increasingly easier to detect chronic diseases such as diabetes, hypertension, and other heart diseases at an early stage. Consequently, this reduces the mortality and morbidity associated with these chronic illnesses (Doty & Holmgren, 2006, p. 5). Nearly 20 percent of individuals in South Carolina who do not have any health insurance coverage are dependent on hospital emergency rooms for routine and general health care. What this means is that patients in such facilities encounter increased waits since resources meant for emergency care have to be diverted elsewhere. Although there are good safety net providers in South Carolina, such as free clinics, community health centers, as well as medication assistance programs, they are not adequate enough to meet the various health care need of the uninsured population in South Carolina.
In South Carolina, minority races have largely been affected due to their low income and high unemployment. The purpose of the research study is to determine the level of racial disparities in accessing health insurance in South Carolina.
Statement of the Problem
It is important to examine the existing racial disparities with regard to differences among blacks’ and whites’ health insurance coverage between African Americans and whites in South Carolina. Access to health insurance is important as it improves the health and wellbeing of people in a given geographical area. However, racial disparities hinder access to healthcare insurance not just among minorities in South Carolina but in the entire United States as well (Cooper, Hill, Powe, 2002; NC Policy Watch 2012). A number of factors contribute to this disparity; however, the main contributing factors include low-income poverty and lack of unemployment. The current research study shall endeavor to examine the existing racial disparities among blacks and whites in South Carolina with regard to access to health care. To do so, the study shall endeavor to answer the research questions below:
Main research question:
“Is there racial disparities in access to health insurance in South Carolina?”
Specific research questions:
- Is there a difference in health insurance coverage between African Americans and Caucasians, aged 16 – 64, in the state of South Carolina?
- How do employment and income affect health insurance coverage between African Americans and Caucasians in South Carolina?
- What is South Carolina doing to improve access to health insurance?
Significance of the study
This research study is beneficial as it will determine the major causes of racial disparities in South Carolina with respect to access to healthcare insurance. In addition, the research study shall also provide solutions that can be adopted in order to improve access to healthcare among minorities in South Carolina. Moreover, the research findings will enable policymakers to implement policies in the healthcare system. In the academic field, the research study will help to narrow the gap between theory and research, thus increasing knowledge on healthcare. Bodies and government agencies with interests in the healthcare sector could also use the research findings to come up with feasible solutions that address the issue of access to healthcare insurance. By analyzing the various study variables, the researcher shall be in a position to identify the strengths and weaknesses of the study. This is useful as a basis for other related studies in the future. In addition, the study shall also enable the researchers to identify the most common socioeconomic factors that are likely to act s the common indicators of health insurance coverage in South Carolina. It is also anticipated that the researcher findings for this particular study shall also act as a basis for other researcher studies to develop recommendations on ways and means of decreasing health insurance coverage disparities among whites and blacks in South Carolina.
Review of literature
Healthcare among the American population has continued to improve, although this improvement is not shared equally across all demographic populations (AHRQ, 2000). For instance, racial groups in the US experience disparities in accessing healthcare insurance despite the presence of federally sponsored health insurance programs. A report released jointly by the UCLA Center for Health Policy Research and the Henry J. Kaiser Family Foundation shows that Whites have higher access to health insurance compared with Blacks and other minorities (Caucasians and Latinos) (Brown, Ojeda, Wyn and Levan, 2000). This has been attributed to demographic factors such as employment, race, and income. The minorities are low-income earners, which subjects them to a low level of insurance cover. In their research, Brown et al. (2000) found out that most of the minority groups are less likely to afford a job-based health insurance cover compared to Whites. This is in spite of an increase in income. Subsequently, minorities lack adequate access to healthcare insurance which exposes them to high child mortality and death rates.
There exist significant disparities among blacks and whites between 18 and 64 years of age in the state of South Carolina with regard to access to health care. Blacks in South Carolina are more likely to lack healthcare insurance in comparison with their white counterparts. In addition, an increasingly larger number of blacks in South Carolina live below the poverty line, have reduced annual incomes, report poorer health statuses, and are likely to be less educated in comparison with their white counterparts (Mead et al., 2008). As a result of lack of health care insurance, blacks are less likely to access adequate health to deal with the relevant health issues. It is important to note that access to health care services is useful to the population in that it aids in the early detection of various chronic diseases. In addition, it leads to reduced mortality and morbidity rates. Elderly adults in the workforce who do not have access to health care insurance are a liability to the state because it has to offset any medical bills incurred by these members of the population. Some of the reasons more black people in South Carolina are less likely to access health insurance, and the associated health care in comparison with their white counterparts include disparities in employment status, educational levels, and income levels among the two groups.
A report released by Kaiser Commission indicates that in 2007, nearly 45 million people in the United States were uninsured. Of these, the majority were blacks (20.9 %), or the equivalent of 9.4 million. On the other hand, 12.2 % of the uninsured people (5.4 million) were whites (Kaiser Commission, 2007). The same report also notes that nearly 17.5% of the residents of South Carolina do not have access to health insurance (Kaiser Commission 2007). At the same time, almost one out of every six individuals in South Carolina does not have access to health care coverage (USDA-ERS, 2011). The reduction in employer-based insurance coverage in South Carolina is also higher in comparison with most parts of the country. Like in other parts of the country, the lack of health care insurance tends to impact the health of people in South Carolina negatively. This has an adverse effect on school performance and the worker productivity of those affected. It is also important to note that even those families who enjoy health insurance coverage are also victims of the increasing number of uninsured people in South Carolina.
It is important to note that low socioeconomic status has an impact on access to health care coverage and, by extension, the health status of the population. A study conducted by Collins et al. (2002) shows that in 2002, nearly 41 percent of the black population in the United States did not have employer-based insurance, in comparison with 30 percent of whites (Collins et al., 2002). Based on these findings, this could perhaps explain why more blacks in the state of South Carolina tend to have higher uninsured rates compared with their white counterparts.
In the state of North Carolina, racial disparities with regard to access to health insurance have persisted for more than a decade (NC Policy Watch, 2012). However, the introduction of the Affordable Care Act is believed to be a major boost in the reduction of healthcare insurance discrepancies. Based on the current report released by the Budget and Tax Center, 82.9% of the Whites of the age below 65 compared with 71.7 % of African Americans who have access to healthcare insurance (NC Policy Watch 2012). Moreover, people of color (such as Latinos and American Indians) have a higher likelihood of not being insured compared with African Americans or Whites. This means that the ability of the minorities to receive medical care is high because they lack access to healthcare insurance and they cannot afford insurance coverage. The new policy under the Affordable Care Act will enhance Medicaid expansion which will, in return, narrow the racial gap in healthcare insurance access and affordability.
The major issues that drive the racial disparities in access to healthcare in the US include work status, education, and income (Mead et al., 2008). As a result, minority races are less likely to afford insurance cover, which makes them prone to poor health conditions. This exposes the minorities to low life expectancy compared with the Whites. Escarce (2008) adds that disparities are high among Hispanic and Black adults and children compared to Whites. In most cases, children of African American origin and other minorities are less likely to have healthcare insurance cover. Shi and Stevens’s (2005) report findings suggest that blacks, Hispanics, and Asians compared to whites, have less access to healthcare, dental visit, and health provider professional visits. These disparities have been attributed to several factors such as high poverty levels, low health status, and low-income levels.
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Research Design and Methodology
Research methodology entails the planning and organization of the research approach with the aim of answering the research study question (Creswell, 2003).
The qualitative research method coupled with exploratory research design shall be applied in the study to allow the researcher to get the opinions, attitudes, and beliefs of the subjects under study (Williams, 2007; Russell, 2005; Prat, 2006; Williams, 2007). Qualitative research will also provide the opinions, views, perspectives, and experiences of the respondents (Runciman, 2002).
The investigator will follow an interview schedule that has a set of prepared questions during the interview sessions (Adams & Cox 2008). During the interview sessions, an audio recording will be carried out after getting consent from participants. Each interview session shall last 45 minutes. The collected data will be analyzed qualitatively. Both thematic and coding analysis will be applied (Maxwell, 2008; Powell & Renner, 2003; Stacks, 2010).
Sample and sampling
A sample of 30 participants will be selected for the research study. A purposive random sampling technique will be used to come up with the sample size. The study targets African Americans and Caucasians aged 16 – 64 years from different households in the age bracket above. Purposive sampling has been chosen because participants will be in a better position to provide valid, reliable, and dependable information aligned to the research topic (Kayaman & Arasli, 2007; Tongco, 2007;
Polonsky & Waller, 2010). To ensure ethical considerations, confidentiality, privacy, and anonymity shall be considered (Fouka & Mantzorou, 2011).
Organization of the study
The research study shall be organized into six chapters. Chapter one is the introduction section. Under this section, the researcher shall endeavor to provide background information on the rationale of the study, statement of the problem, research purpose, aims, and research objectives of the study. Chapter two will be the literature review section. Under this section, the researcher shall review the literature of past research studies related to the topic under study. This shall be followed by Chapter three, which entails the methodology section. Chapter three shall comprise the research methods, sampling, data collection method, and ethical issues considerations. Under chapter four of the research study, the researcher shall endeavor to report the research findings of the study. This is where the results of the study shall be reported and presented. Chapter five shall comprise of analysis of the research findings and discussion. The last chapter is the conclusion of the research findings and recommendations for future study. In addition, the implication of the study and its limitations will also be included.