Ending health care disparities: Equal access to quality care

In 2002, the Institute of Medicine released a groundbreaking report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care."

The report bottom-lined a problem plaguing the American health care system -- that racial and ethnic minorities tend to receive lower-quality health care than whites, even when insurance status, income, age and severity of conditions are comparable.

The evidence the report laid out was both compelling and disturbing. For example, minorities were less likely to be given appropriate cardiac medications or to undergo bypass surgery, and were less likely to receive kidney dialysis or transplants. There also were significant differences in who receives appropriate cancer diagnostic tests as well as sophisticated treatments for HIV infection.

The American Medical Association reacted quickly, calling the report a wake-up call for the profession. Since then, armed with its long-standing policies of zero tolerance toward racially or culturally biased health care, the House of Medicine further has turned up the volume on the need for corrective action -- pledging to use the art, science and skill of medicine to ensure that everyone has equal access to high-quality care.

This response only makes sense. Access to medical care for all people is a cornerstone of the AMA's Principles of Medical Ethics. Additionally, the Association has long encouraged physicians to examine their own practices to ensure equality in medical care and has worked with other medical groups to increase the number of minority physicians so the profession better reflects the face of America.

But the challenge is such that it requires a broad-based response, and that's why last month's unveiling of the Commission to End Health Care Disparities is worthy of attention.

In the planning stages for more than a year and a half, this panel -- created by the AMA and now co-chaired with the National Medical Assn. -- includes leaders from more than 30 of the nation's largest physician and public health organizations. They've joined together around a central goal: to educate physicians and other health professionals about health care disparities while identifying and developing strategies to eliminate gaps in care based on race and culture.

The panel's mission statement lays out the need for collaboration to increase awareness among physicians and health professionals about health disparities. Unequal treatment leads to substandard care -- that alone creates an ethical and professional call to action -- but it also triggers tremendous costs to society, in terms of dollars and in the overall quality and length of millions of lives.

With this in mind, the commission's to-do list is impressive. For starters, it has established four committees to raise awareness, improve data gathering, increase education and training, and promote work force diversity. Also in the works is a comprehensive physician survey exploring the factors that cause health care disparities and efforts to disseminate selected training programs that use case study work, self-assessment activities and video vignettes to increase physicians' cultural competency.

Success will not come easily. After all, findings and recommendations laid out in the Institute of Medicine's 2002 report continue to echo, the problems continue to exist and their causes continue to be complex.

Ultimately, the need for multilayered strategies is also very necessary.

Delivering health care to the diverse American patient population calls for looking beyond a one-size-fits-all approach. Fortunately, the commission is uniquely well qualified to explore and communicate what will work in closing a harmful gap in the delivery of health care.