profession

Health disparities persist as overall care quality slowly improves

A report shows blacks get worse quality care than whites on 41% of quality measures, while Hispanics often receive worse care than whites.

By Carolyne Krupa — Posted May 7, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Health disparities continue to plague the U.S. health care system, but small gains are giving federal officials some hope that progress will be made in years ahead with implementation of the Patient Protection and Affordable Care Act.

The Agency for Healthcare Research and Quality released its ninth annual National Healthcare Disparities Report and the National Healthcare Quality Report on April 20. The reports showed that although overall quality improved at a rate of 2.5% per year between 2002 and 2008, access to care did not.

More gaps in quality of care narrowed slightly during the six-year period than got worse, according to the disparities report.

“For the first time, we are starting to see that — while most disparities are persistent and aren’t going away — we are seeing some improvement in a tiny minority of measures,” said Ernest Moy, MD, MPH, medical officer for AHRQ’s Center for Quality Improvement and Patient Safety. “There is a little bit of good news imbedded in that.”

The congressionally mandated reports are released jointly, because they draw from much of the same data collected from more than 40 sources, he said.

This year’s disparities report showed that blacks received worse quality care than whites on 41% of 182 quality measures. Hispanics received worse care than whites for 39% of 171 quality measures. Some Asians, Native Americans and Alaska Natives received worse care than whites.

In access to care, Hispanics, Native Americans and Alaska Natives had worse access than whites on more than 60% of the studied measures. Compared with whites, blacks had worse access on 32% of 19 measures, and Asian Americans had worse access on 17% of 18 measures.

The greatest disparities were seen in income levels. Most poor people experienced worse access to care than high-income individuals. They received worse care than high-income people for 47% of 98 quality measures.

“As health care costs rise, fewer and fewer employers want to provide it, and fewer want to provide it generously,” Dr. Moy said. “That infringes on low-income and minority populations the most.”

Expecting improvements

AHRQ officials said the reports will take on new significance in the years ahead as a means of measuring the long-term impact of health system reform.

“They lay the baseline upon which we expect to see change,” Dr. Moy said.

The findings highlighted in the reports show the need for provisions under the health system reform law aimed at improving health care quality and decreasing health care disparities, said AHRQ Director Carolyn M. Clancy, MD. The U.S. Supreme Court is considering a case challenging the constitutionality of a provision of the law that would require most Americans to obtain insurance by 2014 or pay a penalty.

“The health care law’s groundbreaking policies will reduce health disparities identified in the report and help achieve health equity,” Dr. Clancy said.

Historically, improvements in disparities are seen in areas where health care professionals have the most control, such as in hospitals and nursing homes, Dr. Moy said. The greatest disparities are seen in areas where the patient has the most control, such as deciding whether to attend smoking cessation classes.

“Those are a lot, lot tougher to change,” Dr. Moy said.

Back to top


ADDITIONAL INFORMATION

The degree to which populations are uninsured

The Agency for Healthcare Research and Quality’s annual report on health disparities showed no improvement in access to care. Whether or not individuals have health insurance coverage is one of several measures the agency uses to gauge access to care among people of different genders, ages, income levels and racial and ethnic groups. The estimated percentages of adults ages 18 to 64 who were uninsured for a full year between 2002 and 2008:

White: 17.3%
Black: 15.6%
Native Hawaiian/Other Pacific Islander: 7.9%
Native American/Alaska Native: 20.8%

Ages 18-44: 18.4%
Ages 45-64: 14.6%

Male: 20.2%
Female: 14.1%

Poor: 32.0%
Low income: 29.8%
Middle income: 16.5%
High Income: 7.4%

Source: “National Healthcare Disparities Report,” Agency for Healthcare Research and Quality, April (link)

Back to top


External links

“National Healthcare Quality Report” and “National Healthcare Disparities Report,” Agency for Healthcare Research and Quality, April (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story