In 2018, I wrote an article called “Medicare, Medicaid, and Mexico: A Transnational Health Insurance Plan” I described a United States-sponsored, globalized health insurance framework that would reward interconnectedness and collaboration. While no one could predict a global pandemic, the need for transnational health insurance has never been more apparent.

What is Transnational Health Insurance?

While COVID-19 has dramatically altered the medical tourism market, the pandemic has also revealed the unsustainable strain put on domestic healthcare providers. Transnational health insurance offers a regulatory framework for medical tourism. Here, medical tourism describes the process of receiving healthcare services abroad, rather than domestically. Due to previous trade commitments, the United States precludes comprehensive health insurance portability. Transnational health insurance offers its customers coverage for pursuing treatment and medicine abroad.

As our world becomes more globalized, there is a strong need for our healthcare systems to follow suit. Coordination, collaboration, and cooperation are all necessary to combat global health crises. While it is impossible to say that transnational health insurance could have stopped the pandemic, there is no doubt the collection and distribution of information between countries would have cultivated greater pragmatism with regards to prevention and preparation.

Scientists have speculated that COVID-19 is not the last of many pandemics that society will face. By encouraging citizens to place trust in global health markets, the United States can pave the way in developing global health security.

Gains from Trade

Economically, transnational health insurance would relieve a huge burden on the typical American consumer of healthcare. For some, it is cheaper to fly to Egypt to fix a toothache than it is to get it checked on in the United States. This stems the United States isolating its healthcare market from competition which artificially keeps prices high. By opening affordable global health care options for American citizens, pharmaceutical companies and hospitals in the United States will be forced to lower prices to compete with global markets.

For the United States, skepticism over foreign medical treatment and complex international trade agreements stagnated industry growth. Transnational insurance solves these issues by creating public trust since all healthcare facilities covered by insurance would need to be vetted and held to higher safety standards. Additionally, transnational health insurance would permit trade liberalization without violating the United States’ trade commitment under the General Agreement on Trade in Services which is currently deterring private investment. This allows the government to encourage a race to the top for quality. Once the market stabilizes in price, high-quality care will determine where Americans get their healthcare. Without a monopoly on treatment, United States hospitals will need to find new ways to incentivize patient intake.

Diplomacy

In times of geopolitical turmoil, scientific diplomacy through health collaboration provides a meaningful way to connect the global community. By developing threads of commonality between citizens of the world, geopolitical crises of all sorts can be mitigated. The insurance and healthcare industry implicates huge aspects of the global economy. By instituting global health norms through regulation and insurance standards, transnational health insurance motivates cooperation on all sorts of topics; countries who would otherwise have unrelated domestic goals, could unite under a common cause for global health by standardizing their healthcare industry to compete for patients from the United States. Ultimately, other countries could adopt similar portability standards which would further strengthen interconnectedness.

Conclusion

Transnational health insurance offers a novel solution to increasing healthcare costs and crises. The capacity of the global community to respond to problems of all sorts give physicians, scientists, and policymakers a mechanism to make our world more interconnected. By developing a global health community, the United States can cultivate a position of leadership in approaching future pandemics.

In the age of mass incarceration, incarceration rates among women have continued to skyrocket over recent years. In 1980, there were about 26,000 incarcerated women in the United States. That number has significantly increased by 700%, to about 222,000 incarcerated women in 2019. With the rates of incarcerated women increasing, the inadequate health care provided to this population is glaringly apparent. Women have specific health needs that must be attended to even while in correctional facilities, including access to menstrual hygiene products. However, incarcerated women are not provided with adequate access to treatment when it comes to their gender-specific health care needs.

Given the majority of incarcerated women are of a younger age demographic, the majority of women incarcerated are thus still menstruating. Common stressors and situations that affect most incarcerated women can have a significant impact on their menstrual bleeding. For example, factors such as poverty, exposure to trauma, addiction, and mental illness can lead to various gynecological conditions. Studies have shown that, as a result of these factors, forty percent of incarcerated women have abnormal menstrual bleeding. Despite this, women in correctional facilities do not have ready access to consistent and quality menstrual hygiene products.

The menstrual hygiene products that incarcerated women do have access to are of sub-par quality. The sanitary napkins that are typically provided at correctional facilities have low absorbency and do not have wings. Along with the poor quality of sanitary napkins, correctional facilities typically do not provide incarcerated women with the appropriate quantity of sanitary napkins needed for their entire menstrual cycle. Women typically need about twenty menstrual hygiene products for a single menstrual cycle, yet many correctional facilities only allot about ten menstrual hygiene products for a woman’s menstrual cycle. Most correctional facilities are also very limited on the variety of menstrual hygiene products they provide. Tampons, for instance, can be considered a scarcity in some facilities given most prisons do not even provide tampons to their inmates.

Furthermore, there is currently no overarching policy in place regarding the distribution of feminine hygiene products in correctional facilities, leading to inconsistency among facilities in the United States. Many correctional facilities give prison guards complete discretion and control over the distribution of feminine hygiene products to inmates. As a result, this leads to prison guards providing unequal treatment to inmates by unevenly distributing the products. This discretion gives prison guards an immense power over female inmates by withholding these products as a form of punishment, or by requiring female inmates to provide something in exchange for receiving these products. Allowing prison guards to have this discretion is a major factor as to why incarcerated women have severely inadequate access to menstrual hygiene products. These are products essential to every woman’s menstrual hygiene, and far too many correctional facilities allow guards to withhold these products as a ploy to punish and humiliate incarcerated women, and thereby deprive them of basic health care.

There are serious health effects at risk when women are deprived of their menstrual hygiene needs. When incarcerated women are deprived of access to menstrual hygiene products, they typically resort to homemade alternativesin order to avoid bleeding through their clothes. These alternatives can be very unhygienic and thus lead to serious infections. Some studies show that mismanagement of a woman’s menstrual cycle can even increase a woman’s risk of developing cervical cancer.

The gender-specific health needs of incarcerated women are severely neglected, especially regarding adequate access to menstrual hygiene products. The most promising solution to eliminating this health inequity is passing new legislation, at both the state and federal levels, that would guarantee female correctional facilities are supplied with sufficient and quality menstrual hygiene products and ensure the products are distributed to inmates in an equitable manner. Women, no matter their situation in life, deserve to receive adequate health care. With proposed solutions and legislation, it is hopeful that incarcerated women will no longer be deprived of their basic health care needs and be provided with better access to menstrual hygiene products.

Native Americans have suffered extreme inequities in health care and health outcomes throughout the history of the United States. However, over the past fifty years, the health care needs of Native Americans have drastically changed as this population becomes increasingly urbanized. To address this new reality and provide legally obligated health care more efficiently and effectively, the federal government must develop new funding mechanisms that either supplement or ideally replace the current Indian National Health Service (IHS).

Treaties in the 1800s between the United States and tribal nations laid the legal foundation for the federal government’s obligation to provide health care services to American Indians and Native Alaskans. The Indian National Health Service, an agency within the Department of Health and Human Services, was established in 1955 to create a more uniform and centralized mode of providing services.  Despite this legal obligation to provide health care, the Native American population has faced significant and continued health disparities. Native Americans currently have a life expectancy that is five and a half years less than the national average and they continue to die at higher rates than all other Americans in many categories of causes of death, including chronic liver disease, diabetes, chronic lower respiratory diseases, assault/homicide, and intentional self-harm/suicide.

One major reason for these disparities is that the IHS has been chronically underfunded throughout its history. According to an analysis by the National Congress of American Indians, in order to match the level of care provided to federal prisoners, funding for the IHS would have to almost double.

Another major issue heightening the health care disparities Native Americans face is that IHS funding is not designed to provide care effectively for the mass migration of Native Americans who have moved from remote reservations into urban areas. Today, around seventy percent of Native Americans live in metropolitan areas, compared with thirty-eight percent in 1990. IHS funding has not reflected this major demographic shift, as there are 54,000 urban Native Americans who lack any access to IHS services or tribally operated facilities. As the New York Times reported, in recent years, on average only about one percent of the IHS budget has been allocated to urban programs.  Urban Indian Health Programs have been established to try and meet the needs of those who fall outside of IHS services, however there are approximately one million people living in the service areas of these nonprofit organizations, creating a demand for service that is far greater than can be met.

This large disparity in federal funding is problematic for many reasons as it clearly fails to meet the federal government’s duties to provide health care under the trust obligation. Given that the program designed to provide services is not reaching or providing care to those in inner cities, the funding system for IHS’s programs needs to be readjusted to reflect the new reality. In addition to readjusted and increased funding, more awareness needs to be created around the issues that urban Native Americans face. As Janeen Comenote, executive director of the National Urban Indian Family Coalition, noted , “[t]his is a population that is invisible…people assume they’re not there and don’t face some of the same issues that impact Native peoples who live on reservations”. Without more outreach programs, education programs, community network groups, and increased funding, Urban Indian Health Programs will continue to struggle to provide adequate health care to urban Native Americans, care that the federal government is legally obligated, yet failing, to provide.