Maintaining and improving the health of individuals is key to a healthy society. Health is connected to every aspect of people's lives and affects their capacity to work, live, and play. The health of Americans is intrinsically tied to the American health care system and is influenced by the way social and economic resources have been organized. The United States is the only industrialized nation that does not guarantee health care for its citizens. As the divide between the "haves" and the "have-nots" grows wider in this society, everyone suffers as a result of the strain that is put on the health care system by those who do not have health care coverage.

Health insurance is the gateway to the US health care system. Without it, even routine health care services can be too expensive for many Americans, resulting in delayed care, prolonged illnesses, and poorer health outcomes. Uninsured patients are more likely than their insured counterparts to

* forego or delay treatment for acute illnesses or injuries,

* go without needed treatment for chronic conditions or illnesses, and

* die prematurely. (1)

Nearly 45 million Americans were uninsured for all of 2005. (2) Many of the uninsured are working but are not able to afford health insurance. This is not only a burden for uninsured individuals, but it also affects private health insurance premiums.

Prices in the private health insurance market are spiraling upward, leading employers to raise the share paid by workers, cut back on benefits, or drop health insurance coverage altogether. As more people lose coverage and the cost of their care is added to premiums for the insured, still more employers will drop coverage. This is a vicious cycle, and the underlying issues contributing to this problem must be addressed. This nation cannot prosper without addressing health disparities and ensuring access to high-quality and affordable health care for its citizens.

HEALTH DISPARITIES

Health disparities have been defined in a number of ways. (3) This article uses the National Institutes of Health definition of disparity, which states that disparities are

differences in the incidence, prevalence, mortality, and burden of
diseases and other adverse health conditions that exist among
specific population groups in the United States. (4)

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Nationally, the commitment to understanding and eliminating health disparities is strong. The Healthy People 2010 initiative, (5) a set of health-promotion and disease-prevention objectives for the nation, aims to eliminate health disparities by the year 2010. This initiative has led to the development of a number of federal programs designed to support this goal through data collection and research. The US Department of Health and Human Services and its agencies spearhead these efforts.

Health disparities analyses typically compare groups and differences in their rates of incidence, prevalence, mortality, and burden of diseases and other health conditions. (6) The most common type of disparity analysis makes comparisons among racial or ethnic groups. (6-9) It is well documented that minority populations--generally classified as African Americans, Native Americans, Asian/Pacific Islanders, and Hispanics--have more chronic diseases, higher mortality, and poorer health outcomes than individuals classified as Caucasian." (10) Race or ethnicity, though important, is not the only characteristic for which disparities can be assessed, however; health disparities can be examined by additional variables such as

* gender;

* income, education level, and other socioeconomic indicators;

* geographic area of residence;

* insurance status;

* primary language; and

* level of acculturation. (11)

The purpose of this article is to examine disparities in health insurance coverage and access to health care services, specifically in the Houston, Texas, area, and the effect these disparities have on the health care system.

THE NATIONAL LEVEL

With an increasingly diverse population, the health of the United States depends on the ability to keep minority populations healthy. According to Census 2000 results, minorities represent approximately 25% of the nation's population. (12) Hispanics, now the nation's largest minority group, represent 13% of the total population, with 12% of the US population citing Spanish as their primary language. (13) Hispanics and Asians account for more an 50% of the nation's population growth; between 2000 and 2050, it is projected that the Hispanic and Asian populations will more than triple, with Hispanics representing nearly a quarter of the total population and Asians representing 8%. (14)

The US Census Bureau estimates that nearly 45 million Americans (ie, 15.3% of the population) are living without health insurance. (2) Levels of health insurance coverage are lower among minority populations, and minority Americans account for half of the uninsured population. (2) Approximately 17% of Asians and Pacific Islanders, 19% of African Americans, and 32% of Hispanics are without health insurance coverage at any given time compared with the national average of 15% and the average for Caucasians of 11%.