Targeted population studies needed to reduce health disparities

Key Points

IT HAS BEEN more than eight years since the Institute of Medicine released an influential report acknowledging the differences in healthcare received by racial and ethnic minorities versus their white counterparts. So how far have plans, healthcare providers, and the U.S. government come in addressing the problem?

"The short answer, unfortunately, is not too far," says Matthew Carlson, assistant professor of sociology at Portland State University (Ore.), and a health services research associate for CareOregon, a not-for-profit Medicaid managed care plan.

Lack of insurance is seen as a major obstruction to healthcare equality, but it's certainly not the only obstacle. Language barriers, cultural misunderstandings, a relative dearth of patient-centered medical research for minority and ethnic populations, and a shortage of primary care physicians are cited as reasons why certain populations lag behind in health status and receive lower quality care.

"The social and environmental determinants of health may be out of our scope, but they're no less important," says Fred Ralston, MD, president of the American College of Physicians (ACP). "A person's education level, their income and the environment in which they live and work can influence their health. Income alone can influence access to education and decent care."

Whatever the causes of health disparities, the numbers bear out their existence. According to the United Nations' Committee on the Elimination of Racial Discrimination Working Group on Health and Environmental Health, racial and ethnic minorities report suffering from poor health at higher rates than whites. For example, 14.5% of African-Americans report being in "fair" or "poor" health compared with only 8% of whites.

African-Americans can expect to live six to 10 years fewer than whites while also facing higher rates of illness and mortality. Hispanics constitute about one-fifth of children in the United States, but they represent more than one-third of uninsured children.

Dr. Ralston says that a significant percentage of racial and ethnic minorities rely heavily on Medicaid, and therefore the number of Medicaid-participating physicians must increase to meet the growing demand. Reform legislation seeks to enhance training of such physicians and improve educational opportunities for minority medical students.

In fact, analysts seem to agree that healthcare reform will help to address the issue of disparities, in large part by improving access to coverage and providing incentives to improve the quality of care within Medicaid.

"The extent to which healthcare reform legislation is able to expand insurance coverage and promote substantive access to preventive and primary care, it has the potential to reduce health disparities," says Katie Coleman of the Group Health Research Institute. "Happily, the awareness of disparities is growing congruently with an empirical understanding of what works to redress them."

Other provisions focus on: improving data collection on race, ethnicity, primary language, geographic area and disability; cultural competency training for providers; and ensuring that information provided to individuals enrolling in Medicaid or purchasing coverage through health exchanges is culturally and linguistically appropriate.

In addition, in order to understand how diseases affect minorities, the Department of Health and Human Services recently awarded more than $14 million to support patient-centered outcomes research. The grants will fund studies of breast and prostate cancers in underserved populations, cardio-metabolic issues in Native Americans and Pacific Islanders, and the effects of health disparities in the Harlem neighborhood of New York City.

ACP and other healthcare advocacy groups are strong supporters of patient-centered medical homes and other prevention-centered, coordinated-care models that have been shown to reduce health disparities. For instance, a survey conducted by the Commonwealth Fund showed that access disparities decrease when care is administered through the medical home model. The new Center for Medicare and Medicaid Innovation will test the medical home model.