The Importance of Reducing Disparities
For more than 20 years, research has documented the persistent gaps in health care quality that disproportionately affect Americans from specific racial and ethnic backgrounds. Many who experience disparate care live in neighborhoods lacking high-quality health services and providers. Our country’s legacy of inequality along lines of race, national origin, language, income, employment, education and housing perpetuate these gaps.1 More troubling still, research shows that racial and ethnic minorities are less likely than Whites to receive heath care of comparable quality regardless of their incomes or health care coverage statuses.2
Despite longstanding research documenting disparities in health care, the overall disparities in quality and access for minority groups and poor populations have not been reduced. For example, comparisons of 2000/2001 data with 2004/2005 data from the 2007 National Healthcare Disparities Report (NHDR) show that many health care measures have gotten significantly worse or have remained unchanged for African Americans, Hispanics, American Indians and Alaska Natives, Asians, and poor populations.
The Agency for Healthcare Research and Quality states that some of the most significant disparities that continue to exist include3:
- Asian adults age 65 and older are 50 percent more likely than Whites to lack immunization against pneumonia.
- African-American children are hospitalized due to asthma at an almost four-times-higher rate than White children.
- New AIDS cases are 10 times more prevalent among African Americans than Whites.
- American Indians and Alaska Natives are twice as likely to lack prenatal care in the first trimester compared with Whites.
- American Indians and Alaska Natives are nearly twice as likely to report poor communication with their health care providers
Data released by the Dartmouth Atlas Project show that African Americans were four times more likely than Whites to develop diabetes complications requiring leg amputations.4 Further, between 2000 and 2002, the quality of diabetes care among Hispanic adults declined by 6 percent, whereas the quality of diabetes care among White adults increased by 5 percent.5
These and many other documented disparities in health care and outcomes are both pervasive and disturbing. Health care inequalities are an affront to the country’s promise of equal opportunity for all, and they impose a tremendous burden on individuals and communities. Healthier Americans of all races and backgrounds make our economy stronger. They stem rising health care costs because healthier Americans need fewer and less costly medical services. Initiatives to reduce disparities and improve care are likely, over time, to yield improved outcomes that may result in long-term cost savings. With escalating health care costs affecting federal, state and employer budgets, it is increasingly important to address disparities and eliminate the financial and economic costs that result from them.
Racial and ethnic disparities in health and health care are caused by a number of complex factors. Therefore, solutions require a comprehensive, multi-level strategy involving everyone in the health care delivery system—including health insurance companies. As a focal point of many quality improvement programs, health insurance companies are in a unique and important position to influence the quality of care that their members receive, including members from diverse racial and ethnic backgrounds. In its seminal 2002 report, Unequal Treatment: Understanding Racial and Ethnic Disparities in Health Care the Institute of Medicine specifically identified the need for health insurance companies to collect, report and monitor patient care data as one solution to eliminating racial and ethnic disparities in care.6
We still don’t have a clear idea of what the magic bullet intervention is,” says Lisa A. Latts, M.D., M.B.A., vice president of Programs in Clinical Excellence at WellPoint, Inc. “So we are all trying. And that’s the beauty of the Collaborative. We are learning from each other.”
In response to the well-documented and persistent racial and ethnic disparities in our country’s health care system, 11 leading health insurance companies combined forces to form the National Health Plan Collaborative (NHPC) to seek out and test best practices to address the issue. The NHPC represents a collective effort by health insurance companies to do their parts to address this serious problem.
In this respect, the NHPC is emerging as a unique national laboratory to develop and test practical approaches to addressing disparities in managed care settings.
1. Lavizzo-Mourey R, Richardson W, Ross R, et al “A Tale of Two Cities.” Health Affairs, 24(2): 313-315, March/April 2005. (http://content.healthaffairs.org/cgi/reprint/24/2/313)
2. Smedley BD, Stith AY and Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The Institute of Medicine, 2003. (http://www.nap.edu/catalog.php?record_id=10260#orgs)
3. 2007 National Health Quality and National Healthcare Disparities Report. Washington: The Agency for Healthcare Research and Quality, 2007. (http://www.ahrq.gov/qual/qrdr07.htm)
4. Fisher ES, Goodman DC, Chandra A, et al. Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project. Princeton: Robert Wood Johnson Foundation, 2008. (http://www.rwjf.org/pr/product.jsp?id=31251)
5. 2005 National Health Quality and National Healthcare Disparities Report. Washington: The Agency for Healthcare Research and Quality, 2005. (http://www.ahrq.gov/qual/nhqr05/nhqr05.htm)
6. Smedley BD, Stith AY and Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: The Institute of Medicine, 2003. (http://www.nap.edu/catalog/10260.html)