Since the U.S. medical system is so expensive, there are many barriers to receiving the best possible care. In addition, the tremendous imbalance of power between the health care consumers and providers creates an institutionalized discrimination for people in less powerful sectors of the population. Making health care decisions can be especially difficult for women who are treated as second-class citizens by medical institutions. This group includes women as a whole, low-income women and uninsured women (who may find that very few choices of providers or treatments are available to them), women of color and older women (whose concerns may be dismissed as "unimportant" or "whining"), and women with disabilities (who may face mobility or communication issues). It also includes lesbian, bisexual, and transgender people and immigrant women, especially those who are not fluent in English. Ultimately, changing current practices will require significant changes in public policy. In the meantime, being aware of how the medical system reflects society as a whole can help you deal with this system and improve the way in which you are treated.
Racism and other forms of bias create barriers to obtaining appropriate health care and health information with which to make decisions. Some providers stereotype women, offering different diagnoses and treatments to women of color and low-income women, even when their symptoms are identical to those of middle-class white women. Providers behave as if lower income women and/or women of color are unable to absorb information about current health issues and do not take the time to explain treatment options. You may yourself feel uncomfortable telling the provider that you do not understand what she or he has said. Providers may not be sensitive to or aware of your needs if you do not share their socioeconomic or ethnic background. Having access to caregivers with backgrounds similar to your own often makes a positive difference.
Those of you who have physical and mental disabilities and chronic illnesses may need to consider other potential barriers, such as the accessibility of transportation and providers' offices, when making health care decisions. Providers are not always knowledgeable about particular disabilities or conditions. Their lack of experience with people with disabilities and the social stigma linked to disabilities may make them uncomfortable interacting with you.
Some lesbian, bisexual, or transgender (LBT) people do not seek health care because they believe that certain services are not necessary. For example, they may incorrectly think that sex between women does not lead to sexually transmitted infections or they do not need regular preventive care.
Bad experiences with providers in the past also affect our decisions about current health care. In addition, those who have partners are often unable to get health insurance through them, because many employers and insurance companies do not provide spousal benefits to unmarried couples.
Workers have to weigh the pros and cons when they decide to call in sick. Here are some of the issues they need to consider:
Collectively, these factors are called "the measure of generosity in granting sick leave."
In essence, workers will accept what their employer gives them. However, if employers do not offer paid sick leave, workers tend to come to work when they are sick.
There is no guaranteed sick leave in the United States but there is in at least 145 other countries.
One study showed that the U.S. grants the fewest number of sick days per employee per year, with five days, while Poland had the greatest number, with 26 days per employee each year.
Statistics also show that as employers reduce sick leave benefits, absences tend to fall as the employer's generosity decreases.
The amount of sick days that individual workers take within a year differs wildly from one country to another, indicating that geography apparently does have some bearing on whether a worker is more likely to call in sick. In Germany, for instance, about 18 percent workers reporting taking a sick day within a 12-month period, while the figure stood at about 8 percent in Ireland. In Poland, the average number of sick day is 26 days a year, while in the United States, the figure stands at five days.
Some factors that determine health disparities between races include socioeconomic status, geographical location, education, cultural beliefs and norms, disease prevalence, healthcare discrimination (including access to affordable healthcare and quality of care) and access to healthy lifestyle options (i.e., fresh food, fitness facilities, recreational sports programs).
Obesity as a primary and secondary condition is the number one reason why healthcare costs are rising. In 2008, overall medical care costs related to obesity for U.S. adults were estimated to be as high as $147 billion. People who were obese had medical costs that were $1,429 higher than the cost for people of normal body weight. Obesity also has been linked with reduced worker productivity and chronic absence from work.
Healthcare reform will not fix the cost of health care in the United States. Each of us will continue to pay more out of pocket costs for services and medications. As Dr. Oz said, we can develop healthier habits including losing weight and exercising. This will decrease the total amount we spend on healthcare. Small changes will add up!
