Vulnerable Populations in the United States

DR. LEIYU SHI is Professor of health policy and health services research in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health. He is Director of Johns Hopkins Primary Care Policy Center. Dr. Shi is also well known for his extensive research on the nation’s vulnerable populations, in particular community health centers that serve vulnerable populations, including their sustainability, provider recruitment and retention experiences, financial performance, experience under managed care, and quality of care. Dr. Shi is the author of eleven textbooks and over 240 scientific journal articles.DR. GREGORY STEVENS is Professor of public health in the Department of Public Health in the Rongxiang Xu College of Health and Human Services at California State University, Los Angeles. His research focuses on health care and social policy, with an emphasis on health equity for vulnerable populations. Dr. Stevens is well known for his work on children’s health and health care disparities, especially in the delivery of primary care and preventive services.

• Figures, Tables, Exhibits xiPreface xvThe Authors xxi1 A General Framework to Study Vulnerable Populations 1Learning Objectives 1Why Study Vulnerable Populations? 3Models for Studying Vulnerability 7The Vulnerability Model: A New Multilevel Conceptual Framework 15Summary 27Key Terms 27Review Questions 28Essay Questions 282 Community Determinants and Mechanisms Of Vulnerability 29Learning Objectives 29Race and Ethnicity 30Socioeconomic Status 43Health Insurance 68Multiple Risk Factors 81Summary 86Key Terms 86Review Questions 87Essay Questions 873 Influence of Individual Risk Factors 88Learning Objectives 88Racial and Ethnic Disparities 89Health Care Access 89Health Care Quality 93Health Status 97Socioeconomic Status Disparities 103Health Care Access 104Health Care Quality 105Health Status 108Health Insurance Disparities 114Health Care Access 114Health Care Quality 116Health Status 119Summary 123Key Terms 123Review Questions 123Essay Question 1234 Influence of Multiple Risk Factors 124Learning Objectives 124Health Care Access 128Quality of Health Care 135Health Status 144Summary 155Key Terms 155Review Questions 156Essay Questions 1565 Current Strategies to Serve Vulnerable Populations 157Learning Objectives 157Programs to Eliminate Racial and Ethnic Disparities 161Programs to Eliminate Socioeconomic Disparities 176Programs to Eliminate Disparities by Health Insurance 186Summary 194Key Terms 195Review Questions 196Essay Questions 1966 Resolving Disparities in the United States 197Learning Objectives 197The Healthy People Initiative 198Framework to Resolve Disparities 205Resolving Disparities in Health and Health Care 210Integrative Approaches to Resolving Disparities 227Challenges and Barriers in Implementing the Strategies 236Course of Action for Resolving Disparities 241Summary 251Key Terms 251Review Questions 251Essay Questions 251References 253Index 281