How Can Health Systems Effectively Serve Minority Communities? Shift the Cost-Access-Quality Axis.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.
In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care.
Our domestic systems of care delivery acknowledge this as a pervasive issue, but have seen marginal success in addressing the challenge. While ethnic minorities continue to bear the major burden of illness in America, health systems are residually tasked with a troubling reality—the sickest patients remain isolated from their services, until they reach critical mass. At that tipping point, the sickest patients require more services than initially needed, leading to increased negative health outcomes and an over-burdened health care system.
True, this is a far cry from the typical 25-piece puzzle; it’s more like a Rubik’s Cube, where plausible solutions rotate in and out of the health care system just as vigorously as those interlocking plastic parts. Health systems are expected to address health concerns and deliver care uniformly, yet this deck is uneven and stacked unfavorably, as evidenced by health disparities. Therefore, the greatest challenge that modern health systems face is how to prioritize minority health; rightfully, it should land at the head of the list, not somewhere in the middle or at the foot.
Addressing this challenge is risky, especially because for-profit, nonprofit, teaching, and community hospitals all have dogmatic differences. Barring structure, most public health or health policy texts would suggest a unifying thread—each system shares vulnerability to the “iron triangle” of health care (cost of care, access to care, and quality of care). These three facets extend well into the minority community, and are often barriers great enough to erect a Berlin Wall between patients and providers. To effectively serve minority communities, health systems must shift the cost-access-quality axis. And within the current health care environment, there exists a tremendous opportunity to actualize that shift by implementing policy, championing leadership efforts, and developing special programs supported by grant funding.
The Affordable Care Act rollouts (which largely address the access barrier and, to an extent, the cost barrier) have taken many substantial bites out of the problem. To echo these proactive efforts, hospital think tanks should own the task of developing culturally competent providers, and provide incentives for their physicians to build interdisciplinary teams that solely troubleshoot minority health issues. In the minority community, affiliate organizations should partner with hospitals to establish programs that celebrate early adopters, and encourage the late majority to seek both preventive care, and to establish a regular primary care plan. Finally, leaders from both the medical and underserved communities should collaborate to identify specific, modifiable threats to minority health. In working with policy-makers, a systematic approach to eliminating these challenges can be created.