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Universal Health Care as a Health Disparity Intervention

Ashwini R. Sehgal, MD
[+] Article, Author, and Disclosure Information

From Case Western Reserve University and MetroHealth Medical Center, Cleveland, OH 44109.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Ashwini R. Sehgal, MD, Center for Reducing Health Disparities, Case Western Reserve University, MetroHealth Medical Center, Rammelkamp Building, Room 213, 2500 MetroHealth Drive, Cleveland, OH 44109; e-mail, axs81@cwru.edu.

Ann Intern Med. 2009;150(8):561-562. doi:10.7326/0003-4819-150-8-200904210-00011
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Health disparities have been the focus of intense scholarly interest over the past decade, with about 2000 articles and 150 books devoted to the subject. To help make sense of this burgeoning literature, I find it useful to categorize work in health disparities into 3 sequential phases. First, in the descriptive phase, we identify the presence of a disparity by race, sex, socioeconomic status, type of health insurance, or some other relevant grouping. Second, in the mechanistic phase, we determine the reasons for the disparity. Third, in the interventional phase, we use our descriptive and mechanistic findings to develop and test an intervention to reduce or eliminate the disparity.

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Universal insurance coverage and health equity
Posted on May 13, 2009
Daiming Fan
Xijing Hospital of Digestive Diseases, Fourth Military Medical University
Conflict of Interest: None Declared

We read with interest the editorial, in which Dr. Sehgal draws a conclusion that universal insurance coverage is the key factor compared with other health care reform efforts in reducing the sizable and persistent health disparities (1). We argue that universal insurance is a necessary condition for health equity, but not a sufficient condition. There is some literature that attests to our opinion. Dr. Bratu found that despite free, universal health care access in Canada, children from lower socioeconomic status areas had increased appendiceal rupture rates, which was an indicator of health disparities (2). Dr. Somkotra assessed the socioeconomic-related (in) equality and horizontal (in)equity in oral healthcare utilization among Thai adults after Universal Coverage policy was implemented nationwide (3). The result was also sad, inequality and inequity in oral healthcare utilization went on. Evidence from Allin's research pointed to persisting socioeconomic inequity in healthcare use, although Canadian provinces have provided universal public insurance for hospitals and physician care for over 30 years (4). Their national trends showed pro-rich inequity in the probability of a GP, specialist and dentist visit. In these studies, except for income, the main socioeconomic determinants associated with inequity are education, type of insurance entitlement, geographic characteristics etc.

In China, the fairness in the health system is very poor. Recently the government approved guidelines and an action plan for reform of the health care system. The state will provide insurance coverage for nearly the entire population. We don't think it will eliminate the health disparities. The precondition of solving this problem should be increasing the supplies of health resources; because the demands of health services expand faster than the mobilization of supplies in our country. How can the limited health resources be shared fairly among the diverse socioeconomic groups? The rich can take priority of receiving health care by spending more money. The bureaucrats are able to use their social relationships in hospitals to get services more easily. The French doctor Gabillat may be right: "Health is victim to social inequalities(5)."


1. Sehgal AR. Universal health care as a health disparity intervention. Ann Intern Med. 2009;150(8):561-562. [PMID: 19380857]

2. Bratu I, Martens PJ, Leslie WD, Dik N, Chateau D, Katz A. Pediatric appendicitis rupture rate: disparities despite universal health care. J Pediatr Surg. 2008;43(11):1964-1969. [PMID: 18970925]

3.Somkotra T, Detsomboonrat P. Is there equity in oral healthcare utilization: experience after achieving Universal Coverage. Community Dent Oral Epidemiol. 2009;37(1):85-96. [PMID: 19191821]

4.Allin S. Does equity in healthcare use vary across Canadian provinces? Healthc Policy. 2008;3(4):83-99. [PMID: 19377331]

5.Gabillat C. Health is victim to social inequalities. Soins. 2008;729:16. [PMID: 18998424]

Conflict of Interest:

None declared

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