The Political Economy of Health Care for Elderly Blacks

Abstract

The author analyzes the influences of race and class on the life chances of blacks by focusing on the health care of black elderly. Theories based on cultural, class, and racial forces are explained in the context of how each would be used to analyze the health care of older blacks. The lower health and socioeconomic statuses of older blacks compared with older whites are documented. The author argues that cultural factors are unable to explain those differences adequately, and that class factors such as the profit orientation of the medical care system, and race factors such as residential segregation and racial discrimination in the medical care system, both contribute to the disparities in medical care. Since proposals for a U.S. national health insurance or national health service fail to include race-conscious measures, the proposals will fail to eliminate existing racial disparities in the health and health care of the elderly.

Racial Disparities in Health Care Access and Cardiovascular Disease Indicators in Black and White Older Adults in the Health ABC Study

“…Third, the Health ABC study did not ask participants questions about their level of satisfaction with their usual medical care providers which may inhibit some older adults from using a particular type of care, even if they have access to it. Finally, although we identify lower quality health care as a problem related to racial disparities in health outcomes, we also acknowledge that racial disparities can reflect health service utilization, such as physician visits, discrimination from and patient distrust of medical staff, and facility location and transportation difficulties (Collins, Tenney, and Hughes 2002; Corbie-Smith, Thomas, and St. George 2002; Schulman et al 1999; Wallace 1990). However, these issues were not addressed in Health ABC.…”

“…The political economy perspective on aging (Quadagno and Reid 1999) suggests that differential exposure to decades of racial and socioeconomic inequalities in education and employment helps determine long-term availability of and access to health care. Older Black adults are more likely than older White adults to suffer disadvantages in health care in the past, where their greater likelihood of having public or poorer quality private health insurance and access to care may negatively impact their current health status (Blendon et al 1989; Quadagno 2000; Wallace 1990). Even today, older Black adults encounter a variety of difficulties in accessing medical care, including preventive and acute care, surgeries, prescription medications, and long-term care that are likely to impact their current health (Fillenbaum et al 1993; Lee et al 1997; Mui and Burnette 1994; Schulman et al 1999; White-Means 1995, 2000; Wallace et al 1998).…”

“…Even today, older Black adults encounter a variety of difficulties in accessing medical care, including preventive and acute care, surgeries, prescription medications, and long-term care that are likely to impact their current health (Fillenbaum et al 1993; Lee et al 1997; Mui and Burnette 1994; Schulman et al 1999; White-Means 1995, 2000; Wallace et al 1998). In addition, compared to older White adults, they are more likely to experience structural barriers to medical care, such as residential segregation, limited income and health insurance, and distant proximity to medical facilities, as well as a lack of knowledge about available services and new medical procedures (Wallace 1990). …”

Health Status Gender Differences of Newly Admitted Black Nursing Home Residents

“…Moreover, it is suspected that the same supports would also differently affect the ability of black male and female nursing home residents to perform ADLs. Although health care for monitoring of health events and preventive care are encouraged for all older adults, community‐living black older women have limited access because of their substantially lower income than black older men 54 and lack of access to government‐funded preventive and maintenance health care available to predominantly male veterans. Black older women may have Medicare, but Medicare alone is inadequate to finance all preventive, maintenance, and long‐term health care needs since, as a group, they experience a high incidence of chronic illness and poor health status 22 .…”

Racial Patterns in Disabled Elderly Persons' Use of Medical Services

“…Are elderly ethnic minorities more likely to experience no-care zones and service gaps in community-based care commonly used by older persons? We know that minority elderly persons are more likely than White elderly persons to face many of the structural barriers noted above, to lack knowledge about new medical techniques, and to evaluate medical services as culturally insensitive and/or racially discriminatory (Wallace, 1990b;Whittle, Conigliaro, Good, & Joswiak, 1997). However, no conclusive research ascertains whether minority elderly persons are obtaining a mix of long-term care services that meet their needs (Markides & Wallace, 1996).…”