As pharmaceutical companies and politicians scramble to disseminate the COVID-19 vaccine, one thing has become clear – accessibility is not equal. Insights@Questrom spoke with Joseph Restuccia, Everett W. Lord Distinguished Faculty Scholar and Professor, Operations & Technology Management, to learn what factors affect access to quality healthcare and how we can ensure equal access to the coveted vaccine.
Question 1: What factors and social determinants affect access to quality health care, and which populations are not receiving equal access?
Restuccia: The major factor is poverty. Of the nearly 30 million uninsured in the U.S., more than 70 percent do not have sufficient income to afford health insurance despite having at least one family member with a full-time job.
Somewhat ironically (and cruelly), many uninsured are not eligible for Medicaid because their income is too high; the maximum for a family of four in Massachusetts is about $35,000/year and less in many other states. Those who belong to a racial/ethnic minority group such as Black, Hispanic, and American Indian are more likely to be poor due to systematic discrimination and thus more likely to be uninsured.
It’s worth noting that contrary to common belief, not everyone is eligible for health care in an emergency department (ED). An ED is required to provide care only to “stabilize” a patient who has an emergent condition but not to provide further care. The one other area where federal law requires that care be free of charge is Covid-19 testing and vaccination. However, payment for Covid-19 treatment is the patient’s responsibility whether they have insurance or not.
Question 2: We are seeing that Blacks are not receiving the COVID-19 vaccine at the same rate as whites. What is causing this discrepancy?
Restuccia: There are several reasons for this discrepancy. One is less access to healthcare, as discussed above. A second reason is that the U.S. Center for Disease Control did not designate Blacks, or other racial/ethnic groups, as a priority for receipt of the vaccine. This is despite Blacks having 1.4 times the incidence, 3.7 times the hospitalizations, and 2.8 times the mortality rate from Covid-19 compared to Whites (Hispanics rates equal to or higher than those of Blacks). In general, Blacks have higher exposure to the virus due to crowded housing conditions, reliance on public transportation, and inability to work from home, and inability to take time off from work to seek health care due to financial pressure. Third, Blacks are more likely to have problems to access the internet, which is the primary and often only way of making an appointment for vaccination. Finally, many Blacks do not trust the healthcare system due to discrimination going back at least to the Tuskegee health study, begun in the 1930s and lasting four decades, in which Black men with syphilis were left untreated despite being told they were receiving treatment.
Question 3: How can the US ensure that communities of color have equal access to the vaccine?
Restuccia: Perhaps the most important action would be for the states, which have the ability to modify CDC priorities and are ultimately responsible for vaccine distribution, to establish vaccination centers in communities of color. This is being done in Massachusetts, but only several weeks after the start of vaccine distribution, in neighborhood health centers and other community-based locations. Another useful but late addition to the state’s vaccination plan is a call center to help make appointments without the need to access the internet. The mistrust of the health care system could be addressed by measures such as working with the community and religious groups to provide education about the safety and benefits of vaccination and going door to door to provide vaccinations especially in neighborhoods with a high elderly population and/or difficult access to health care facilities.
Efforts to get people of color, the elderly and everyone vaccinated are not only of benefit to those receiving it but to all of us, especially since the longer it takes to vaccinate the vast majority of the population, the more opportunity the virus will have to mutate. As stated in the Washington Post, “a less-than-vigorous vaccination program would prevent Americans from recovering some semblance of their pre-pandemic lives and would also increase the likelihood that new, potentially vaccine-resistant variants will become dominant in the United States.”