Unequal Treatment: Disparities in Access, Quality, and Care
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1 Unequal Treatment: Disparities in Access, Quality, and Care Brian D. Smedley, Ph.D. National Collaborative for Health Equity
2 Healthcare Disparities: Are We Making Progress? Despite historic gains in insurance coverage resulting from the ACA, people of color still face high rates of uninsurance relative to white Americans Even when they possess insurance, many in communities of color continue to face a variety of economic, geographic, cultural, and linguistic barriers to accessing care People of color continue to receive a lower quality of care relative to whites, even when access is equivalent These inequities illustrate how racism operates at multiple levels structural, institutional, and interpersonal to affect the health of people of color
3 ACCESS DISPARITIES: During the first half of 2014, declines in rates of uninsurance were larger among Black and Hispanic adults ages than among Whites, but racial differences in rates remained Adults ages who were uninsured at the time of interview, by race/ethnicity, White Black Hispanic Percent Jan-Mar 2014 Apr-Jun 2014 Source: National Healthcare Quality and Disparities Report, 2014.
4 ACCESS DISPARITIES: In 2012, disparities were observed across a broad spectrum of access measures Disparities: Access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group, % Better Same Worse 80% 60% 40% 20% 0% 19 Poor vs. High Income (n=19) Black vs. White (n=21) Hispanic vs. White (n=21) 6 4 Asian vs. White (n=18) 9 AI/AN vs. White (n=13) Source: National Healthcare Quality and Disparities Report 2014.
5 QUALITY DISPARITIES: Disparities remained prevalent across a broad spectrum of quality measures Disparities: Number and percentage of quality measures for which members of selected groups experienced better, same, or worse quality of care compared with reference group 100% 80% 60% 40% 20% 0% Poor vs. High Black vs. White Income (n=109) (n=165) Better Same Worse Hispanic vs. White (n=150) Asian vs. White AI/AN vs. White (n=146) (n=85) Source: National Healthcare Quality and Disparities Report 2014.
6 QUALITY DISPARITIES: Through 2012, some disparities were getting smaller but most were not improving across a broad spectrum of quality measures Change in Disparities: Number and percentage of quality measures for which disparities related to race, ethnicity, and income were improving, not changing, or worsening from 2001 through % 80% 13 Improving No Change % 40% % 0% Poor vs. High Income (n=98) Black vs. White (n=148) Hispanic vs. White (n=130) Asian vs. White (n=123) 4 AI/AN vs. White (n=64) Source: National Healthcare Quality and Disparities Report 2014.
7 The Causes of Healthcare Access and Quality Inequities are Multiple and Influence Each Other (IOM, 2002): The mal-distribution of health care resources relative to community need created and reinforced by residential segregation and market forces Medical apartheid separate and unequal care Institutional policies and practices (e.g. failure to respond to growing ethnic and linguistic diversity) Provider biases often implicit and aspects of the clinical encounter
8 Equity in Healthcare Delivery: Aligning Resources with Community Need People of color are disproportionately concentrated in health professions shortage areas and medically underserved areas 28% of Latinos and 22% of African Americans report having little to no choice in where they access care, compared to only 15% of whites 34% of Latinos, 24% of AI/ANs, 19% of African Americans, and 15% of whites report having no regular source of health care Source: Kaiser Family Foundation, 2008.
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11 Examples of Needed Steps to Advance Equity in Healthcare: Create incentives to better align healthcare resources with community needs Address health workforce needs, including training on implicit bias, increasing diversity among providers Publicly report and monitor healthcare access and quality inequities Prioritize elimination of access and quality gaps as part of payment reform
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