Socioeconomic Disparities in Otolaryngology: No Easy Explanations, No Easy Answers

According to Joel Miller, Senior Vice President for Operations of the National Coalition on Health Care (NCHC), a nonpartisan group that does research on socioeconomics and health care for its 75 member groups and the public, studies show that 47% of Americans delay getting needed medical care because they either lack insurance or cannot afford the out-of-pocket medical costs.

About 90 million people, or one-third of people below age 65, spent all or part of 2006 and 2007 with no health coverage. Yet, Mr. Miller pointed out, Seventy percent of the people in the United States who have no health insurance coverage reside in families that have full-time workers. So the myth that the uninsured are people who are unemployed, slackers, or below the poverty line or are homeless just isn’t true, he said.

The number of employers offering health insurance has plummeted in recent years due to high costs, especially among the small and medium-size employers who can’t afford the premiums.

Studying and learning about SES as it relates to health care is important, not only for better understanding of individual patients, or learning how it affects medical practice, but also for knowing how it affects groups within the population, as well as society as a whole.

When uninsured people present late with disease, their subsequent treatments (for more complex disease) have much higher costs. And the higher costs associated with treating late-presenting patients are spread out across other payers via premiums, Mr. Miller said. Those other payers include the employers who do offer health coverage, as well as individuals. It affects businesses and the general economy in other ways, too.

As overall health care costs rise, corporate operating margins are cut, and companies have less capital for expansion or development, making them less competitive. An Institute of Medicine study showed that $130 billion a year is lost to businesses due to postponed care by uninsured patients, Mr. Miller said. The NCHC is working with various levels of government, medical associations, and other groups to try to develop solutions for these problems.

We are advocating for comprehensive health care reform, Mr. Miller said. All these issues highlight the importance of studying SES in medicine.

Oropharyngeal Cancer and SES

Several studies in the medical literature highlight different SES factors as they affect areas within otolaryngology specifically. A study by researchers at the M. D. Anderson Cancer Center in Houston looked at sociodemographic factors as they related to survival among patients who underwent radiation therapy for squamous cell carcinoma of the oropharynx (SCCOP).