QUALITY: Health Reform Will Work To Eliminate Health Disparities
With so much ruckus over what's in the House health reform bill, what's not actually in the bill and what imaginary horrors it will bring about , we'd like to highlight a feature not getting much attention -- namely a push to reduce or eliminate health disparities.
Here are some of the highlights from the House Tri-Committee bill, HR 3200:
- Medicare will reimburse for "culturally and linguistically appropriate services" to promote access for Medicare beneficiaries with limited English proficiency. (NOTE: This is not a codeword for covering illegal immigrants, as some foes of reform have contended).
- Reducing health disparities would be an explicit goal in the HHS Secretary's national priorities for quality improvement in health care.
- The Secretary of HHS and the Institute of Medicine would look at how providers utilize cultural and linguistic support services, design a demonstration program to pay for these services, and study the impact on reducing health disparities.
- Establish a CDC grant program for community-based prevention and wellness. Significantly, "At least 50% of these funds must be spent on implementing services whose primary purpose is to reduce health disparities."
Many health advocates are excited about these provisions in the bill. Last week, our Health Policy Program Director, Dr. Len Nichols, discussed them at an event held by The National Partnership for Action to End Health Disparities.
To combat health disparities, we need to start by acknowledging and understanding them -- and making their reduction a high priority in legislation. It is a central part of access equity, and it's germane to quality of care. Our reformed health care system should not tolerate disparities.
What kind of problem do health disparities present? The IoM in its 2002 study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found that all other things being equal -- insurance status, income, age, and severity of conditions -- medical treatment varied by race. This means that racial and ethnic minorities are more likely to stay sick even when they seek care. They don't get the same quality of care, they are less likely to have health insurance coverage, or they have limited or substandard coverage -- the kind that leaves them with bank-breaking deductibles when they do get sick. No single factor explains this phenomenon, but patient attitudes, provider biases, and unconscious stereotypes all play a role.
Linguistic and cultural barriers can frustrate patients and doctors. Not all doctors are great at breaking down medical jargon into terms their patients can understand -- even when both speak the same language. Even for skilled translators, it can be daunting to communicate the complexities of medical diagnosis, treatments and follow up procedures. Doctor and patient should be able to work as a team to accomplish mutual goals for patient care. That means, too, the ability to understand and communicate a patient's values and goals of care. The linguistic and cultural support services provided by health reform legislation will help.
As we've mentioned previously, a recent Health and Human Services study found that racial and ethnic minorities face higher rates of disease, especially chronic disease such as cancer, diabetes, or HIV. Of the approximately 46 million uninsured, about half are poor and one-third suffer from chronic disease, according to healthreform.gov. For more detailed statistics on health disparities, check out the group health profiles on the Office of Minority Health website or the Kaiser Family Foundation's statehealthfacts.org.
The challenges of health disparities deserves our attention. We've written frequently about how it is morally unacceptable for hard-working American to be sicker, die younger, and receive poorer care than his or her fellow Americans because they lack insurance. We cannot allow our fellow Americans to suffer from such problems more frequently simply because they are a member of a racial or ethnic minority.
If we want to eliminate health disparities, we must commit to an honest dialogue. Race, inequality, and discrimination are complex subjects that can be difficult to discuss, but they cannot be glossed over or ignored. Honest dialogue includes discussions about eating and exercising habits, possible incentives, as well as community-enhancing investments in access to fresh foods and walking-friendly physical environments. (The Robert Wood Johnson Foundation's Commission to Build a Healthier America has done a lot of work on healthy neighborhoods, and we've written about it several times, including here.)
As Americans, we have to commit to solving this problem on all levels -- in both the private and public sector, and especially in our communities. The provisions in the House health reform bill are a good step forward, but they alone aren't going to solve the problem of health disparities.