Does Laboratory Medicine Worsen Health Disparities Unintentionally?
More Programs and Publications Featuring Dr. Marilyn Bibbs Freeman
In this program:
Are health disparities sometimes worsened unintentionally by laboratory medicine? Dr. Marilyn Bibbs Freeman from Virginia Department of General Services Division of Consolidated Laboratory Services (DCLS) discusses cost issues and systemic issues with laboratory medicine and the U.S. healthcare system.
Transcript
Interviewer:
Dr. Freeman, recognizing global genetic diversity, does laboratory medicine unintentionally exacerbate health disparities, especially in terms of cost, and how can we increase economic access to testing for more patients and communities?
Dr. Marilyn Bibbs Freeman:
So yes, I do believe that laboratory medicine unintentionally exacerbates health disparities. I also believe that in some cases, it intentionally exacerbates health disparities, and I'll take a little time to try and explain that now. Health-rated data is really reflective of the communities in which it was collected in the first place. Sometimes by chance, and other times by choice. The data that we collect doesn't reflect the marginalized communities in which we live, play or work. So we have left our recommendations and health algorithms based on data for communities where the information was collected, it doesn't represent them. We have data that supports the majority class, so the conversation around health economics and is honestly a whole doctoral program in itself, and some of these decisions that we have made with algorithms and recommendations, we have outpriced in many cases, what's affordable to many people based around the specialization of care, based around what health insurers will cover and will not cover, and then you'll find as we talk a little bit more in this question that there's some intersectionality around employment and socio-economic status that may be impactful as well.
The U.S. has really the highest spend on health-related costs, that's really just no surprise to anyone, but we really don't have proportional positive health impacts, when comparing ourselves to other countries. The reasons are really numerous, and those reasons are systemic. A simple answer to the question is not really possible around health economics and access, the entire system really needs to be evaluated and re-worked. So let's think about a couple of things. The majority of health insurance in the form of private payer through a person's employment. Those who are unemployed have to rely on public services for payment, or if they are lucky enough, have historical wealth that they can actually use to pay for their insurance. So we're seeing this intersectionality between what people are actually being covered for through their insurance and what they can afford to pay for. So in theory, if we can increase the rates of employment, we may be able to increase the rates that people are insured and hopefully have an effect on health care. Recognizing that the poorest people in the country are also really responsible for the highest healthcare costs and the ones driving costs up in a lot of cases.
As a public health practitioner, I'm in an interesting space where we really don't function in a private payer health insurance system here in my state. And so we really have to look very closely at how we are utilizing our funds, and we have to be sure that we are meeting the needs of those that are in the greatest risk for health impacts that are negative. So I really believe that we haven't really looked closely enough at the services that the public system can provide at minimum to no cost, we've learned through research that prevention is much more cost-effective and you get a better return on interest if you can prevent disease instead of being reactionary and addressing it when it happens. So there's just really a lot of different pieces and that can be a whole doctoral study in itself, but just a couple of high level things I'll kind of just circle back to is looking at socio-economic status and the employment rates and the systems around employment and what can be available. Even with that, we really need to begin taking a closer look at what insurers are covering and the cost that service providers are charging because in one part of the state for the same test, you can find costs that are four times as much that if you were to go to another service provider.
Interviewer:
Yes, and I like what you said about how there can be suggestions in terms of how people should care for themselves, but it might not necessarily be attainable. And I mean, I have insurance, but I think for the first time ever in my life, I've met my deductible earlier this year, which gave me the ability to go beyond just seeing my primary care provider, I went to an ENT specialist and all these other people for things that I usually don't go to and it was covered and it was fine, but it required that sacrifice of me meeting that $3,000 deductible, not everyone, especially I definitely say also younger people, not everyone really has the opportunity to have access to especially specialized care. And there's a lot of things that you have to do annually for specialized care that you're supposed to be doing annual gynecologist visits and annual eye visits and things like that that are also expensive if they're going beyond what your insurance will cover for a primary care provider, so all of that is very, very expensive, and I'm glad you mentioned that.
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