Vulnerable populations are groups that are not well integrated into the health care system because of ethnic, cultural, economic, geographic, or health characteristics. This isolation puts members of these groups at risk for not obtaining necessary medical care, and thus constitutes a potential threat to their health. Commonly cited examples of vulnerable populations include racial and ethnic minorities, the rural and urban poor, undocumented immigrants, and people with disabilities or multiple chronic conditions.
The reasons for disparities are varied. For example, in access to health care, racial and ethnic minorities may lag behind non-Hispanic whites because patterns of residential segregation separate minorities from the supply of providers, because of language and cultural barriers between doctors and patients, or because of differences in employment patterns that lead to lower rates of employer-based insurance coverage for some groups.
Persons with disabilities and multiple chronic conditions may find it difficult to obtain insurance coverage because small employers cannot afford to add workers to their health plans who are likely to have high medical costs, and finding an affordable insurance plan as an individual with pre-existing conditions is very difficult. The geographic and economic isolation of some poor rural residents may make access to specialty care difficult, even if they are covered by insurance. Finally, prohibitions against public insurance coverage, fear of being discovered, and language barriers are all factors that may keep undocumented immigrants from seeking care.
The recently enacted health reform law has the potential to reduce many of the barriers related to insurance coverage. Prohibitions against basing premiums and offers of coverage on preexisting conditions, the establishment of a robust individual and small group insurance market, and the expansion of subsidies to large groups of low-income families should make it easier for many vulnerable populations to improve their integration into the health care system. Other groups, however, are still likely to be disadvantaged even after reform. For example, undocumented immigrants are explicitly excluded from the many parts of the reformed system, and it remains to be seen whether the supply of culturally competent health care services to underserved areas and groups increases as overall rates of coverage increase.
At The Urban Institute, the study of disparities intersects with many other areas of our research, including private insurance, the uninsured, long-term care, public health, and Medicaid/SCHIP. Recent examples of our work include studies of:
• Geographic patterns of disparities between Latinos, African Americans and non-Hispanic whites in access to care;
• The cost of racial/ethnic health disparities in terms of excess health care spending;
• The impact of health reform in Massachusetts on several vulnerable populations;
• Differences across states in the urban/rural gap in access to care;
• National disparities between Native Americans and non-Hispanic whites in insurance coverage and access to care;
• Insurance coverage gaps for people with disabilities;
• The effects of language differences in access to care for Latinos in the U.S.;
• The labor market consequences of race differences in health.