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Lack of Healthcare Availability and Poverty Go Hand-in-Hand for Detroit and Other Major U.S. Cities

Health insurance businessA recent data analysis by the Pittsburgh Post-Gazette and the Milwaukee Journal Sentinel shows that there is a rapidly declining number of hospitals in poor metropolitan areas in the United States.

The data also revealed that those hospitals and family doctors’ offices aren’t closing down — they’re just moving to more affluent areas.

Further research shows that people who live in poor neighborhoods are not only more likely to suffer from poor health but to experience a shortage of available physicians in their areas, too.

Yet those doctors are following the patients with private insurance rather than continuing to care for poorer populations.

As a result, the analysis showed that nearly two-thirds of about 230 hospitals that have opened since 2000 are in wealthier areas, typically those in the suburbs.

As newer suburban hospitals have opened, the urban ones have closed, especially small to mid-size community or public hospitals, leaving low-income residents without a nearby hospital. In 52 major U.S. cities, the number of urban hospitals has fallen from 781 in 1970 to 426 in 2010, a decrease of 46 percent in just 40 years.

In New York City, all five boroughs have lost more than 20 hospitals since 1990.

Detroit had dozens of hospitals in the 1960. Now there are only four to serve a population of about 700,000, perhaps the most dramatic loss for all large cities.

Figures from 2008 reported that at least one in four Detroit residents are without health insurance. That same year, the only hospital on the city’s troubled east side, Riverview Hospital, shut down for good.

The problem affects smaller, rural areas, too, where “medical deserts” are being created due to the lack of available healthcare to residents in these small town areas where many poor residents also live.

In the years between 1990 and 2010 only, over 200 hospitals closed. The number of non-profit hospitals closing their doors in the largest cities has been 148; for-profit hospitals have experienced 53 of those closures.

Five public hospitals have also closed.

Alan Sager, of Boston University, has tracked these hospital closures. He concludes that the ones being shut down were actually rated as more efficient than the ones that remain, something that he says wouldn’t happen in a true free market system.

These poorer communities experience a shortage of doctors, as well. Of the nation’s 5,800 federally designated “primary care shortage areas” in the largest 52 cities, 58 percent fall into the census tracts where the highest levels of poverty exist.

At least one in five people live in these shortage areas; those same areas have higher than average populations of people with disabilities.

These areas don’t only face the issue of fewer hospitals and doctors. Health problems are simply more likely to occur based on their surroundings.

For example, as many as half of people who work report having experienced back pain in the United States. Members of the working poor who can’t afford care, can’t take time off of work, or can’t afford to travel to a suburban hospital have to suffer through it, though.

This is only one of many problems that keep the urban poor isolated by poverty. Many are less likely to have jobs, vehicles and access to health food but more likely to face violence in and around their homes.

Living conditions can keep people both poor and sick, too: imagine a child with asthma who lives in a mold-filled apartment or a diabetic who can’t afford a refrigerator to store insulin. Those who are homeless fare no better, as living on the streets can easily open up the risk for infections and disease.

The Center for Disease Control found that early death is a much higher risk for those in low-income areas. In higher-income U.S. counties, the average deaths before the age of 75 was 345 per 100,000; in lower-income counties, the average was 480.

Those poor areas that experienced more premature death had lost far more hospitals and doctors.

No clear solution exists to the problem, however. Many experts point out that these issues have worsened in recent years due to the prevalence of private health insurance aimed mainly toward those who can afford it.

There are also more specialists in the United States than in other countries; roughly two-thirds of physicians have a higher-paid specialty such as oncology or anesthesiology. Those doctors that earn more are likely to work in larger hospitals with more affluent patients.

Meanwhile there are only half as many family doctors per thousand people in the U.S. as there are in other developed countries. The reason could be spurned by the massive amounts of education debt faced by medical students, which pushes them into these high paying specialties.

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