Excerpted From: Twenty Myths About National Health Insurance
December 1991
W62
Rationing by Racial/Ethnic Group
Critics of the U.S. health care system often point to the disadvantages faced by minorities. On the average, African-Americans and Hispanic-Americans are less likely to have health insurance, see a physician or enter a hospital. But is national health insurance the answer?
Both economic theory and empirical studies show that minorities fare worse under systems of nonprice rationing than they do in a marketplace where prices allocate resources. What little evidence we have about health care rationing in the United States is consistent with experience in other fields.
Take the rationing of organ transplants, for example. According to the United Network for Organ Sharing, whites received 97.6 percent of the pancreases and high percentages of livers, kidneys and hearts in 1988. The Pittsburgh Press found that where the donors were not living relatives, the average wait for a kidney transplant in 1988 and 1989 was 14 months for black patients and only 8.8 months for whites. Note that in addition to race, income also matters. A study by the Urban Institute found that for black and white males, the higher their income the more likely they are to receive an organ transplant.
"Infant mortality rates are three times greater than for the rest of Quebec among the Crees and four times greater among the Inuits."
There have been very few studies of how racial minorities fare under national health insurance in other countries. In a recent study of the Inuits and Crees of northern Quebec, both groups had much less access to health care than Caucasians in southern Quebec and in other areas of Canada - despite their much greater health needs. For example:
- The age-adjusted mortality rate for Inuits is almost twice the rate for Canadians as a whole.
- Infant mortality rates are three times greater than for the rest of Quebec among the Cree and four times greater among the Inuits.
- Life expectancy at birth in 1978 was only 58.9 years for Inuit males (compared to a Canadian average of 72 years) and 61.6 years for Inuit females (compared to a Canadian average of 79 years).
About 45 percent of the aboriginal people of Ontario live in the rural, northern part of the state. And, as in the case of Quebec, the northern counties are underserved:
- In 1986, there were no specialists in allergies and immunology, geriatrics, infectious diseases and pediatric surgery in all of northern Ontario.
- There was only one specialist in dermatology, endocrinology, nephrology, neurology and rheumatology.
When national health insurance was adopted in 1969, Ontario also adopted a program to encourage physicians to move to rural areas - one of the longest running programs of its kind in the world. Yet a recent study concluded that "while some change has been made, northern Ontario is as underserviced compared to the rest of the province as it was in 1956.""Although they have a higher incidence of heart disease, the Maoris of New Zealand receive many fewer heart operations."
New Zealand also has both a significant minority population (the Maori) and a comprehensive system of socialized medicine. One study reported that:
- New Zealand’s Maoris have an infant mortality rate 60 percent higher than non-Maoris.
- Life expectancy for Maori males and females is, respectively, 7 and 8 years lower than for other New Zealanders.
- Only 20 percent of these differences can be explained in terms of socioeconomic factors.
There is also evidence that the Maoris get significantly less health care " especially in relationship to the need for it " than other New Zealanders. For example:
- Death from coronary artery diseases is significantly higher among Maoris - 3.5 times as high, for example, among females age 25 to 44.
- Yet Maoris receive only a tiny fraction of the coronary artery bypass operations - well below their percentage of the population.
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