Department of Medicine, University of California, San Francisco, CA, USA.
City University of New York School of Urban Public Health at Hunter College, New York, NY, USA; Harvard Medical School, Boston, MA, USA.
Lancet. 2017 Apr 8;389(10077):1431-1441. doi: 10.1016/S0140-6736(17)30398-7.
Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. Other articles in this Series address population health inequalities, and the health effects of racism, mass incarceration, and the Affordable Care Act (ACA). Poor Americans have worse access to care than do wealthy Americans, partly because many remain uninsured despite coverage expansions since 2010 due to the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health-care resources devoted to care of the wealthy has risen. Additional reforms that move forward, rather than backward, from the ACA are sorely needed to mitigate health and health-care inequalities and reduce the financial burdens of medical care borne by non-wealthy Americans.
美国经济不平等的加剧伴随着健康结果差距的扩大。现在，最富有的美国人的预期寿命比最贫穷的美国人高出 10-15 年。本报告是美国健康和不平等问题系列报告的一部分，重点关注医疗保健系统本应减少收入导致的健康差距，却反而常常加剧这些差距的现象。该系列的其他文章探讨了人口健康不平等问题，以及种族主义、大规模监禁和《平价医疗法案》（ACA）对健康的影响。与富裕的美国人相比，贫穷的美国人获得医疗服务的机会更差，部分原因是尽管自 2010 年 ACA 实施以来，覆盖面有所扩大，但仍有许多人没有保险。对于有私人保险的个人来说，保费上涨和成本分担削弱了工资增长，导致许多家庭陷入债务甚至破产。与此同时，用于富人医疗保健的医疗保健资源份额有所上升。迫切需要进一步推进而不是倒退 ACA 的额外改革，以减轻健康和医疗保健方面的不平等，并减轻非富裕美国人的医疗费用负担。
