Health disparities persist despite quality improvements

States are doing better on health care quality, but progress in cutting racial and income disparities has been harder to achieve, according to data released in June by the Agency for Healthcare Research and Quality.

The state-level information now available at the ARHQ website summarizes data on overall quality and performance related to conditions such as cancer, diabetes and heart disease. The website also presents the measures on which each state fared the best and the worst compared with other states.

The state-level data is based on information drawn from AHRQ's 2010 National Healthcare Quality and Disparities Reports published this spring (link).

Overall, those reports show improvements in about two-thirds of 179 health care quality measures tracked by the federal government. But only 30% of 22 measures of access to care showed improvement, while 30% remained stagnant and 40% showed declines.

"Every American should have access to high-quality, appropriate and safe health care," said AHRQ Director Carolyn M. Clancy, MD. "We need to increase our efforts to achieve that goal because our slow progress is not acceptable."

The reports show that blacks had worse access to care than whites for one-third of six core measures, such as having a usual primary care physician and insurance coverage. Hispanics had worse access than whites for five of six core measures.

People living below the federal poverty level had worse access to care than high-income individuals in all six core measures (link).

Concerning quality of care, blacks, American Indians and Alaska Natives received worse care than whites for about 40% of core measures. Hispanics received worse care than whites for about 60% of core measures.

States showing the greatest overall quality improvement in 2010 were Maine, Massachusetts, Minnesota, New Hampshire and Rhode Island. Those showing the least improvement were Kentucky, Louisiana, New Mexico, Oklahoma and Texas.

"States are so different," said Ernest Moy, MD, MPH, medical officer of the AHRQ Center for Quality Improvement and Patient Safety. "They have different populations, different resource levels and different mixes of providers."

Wide variability in health care nationwide is one factor that makes decreasing disparities in care so difficult, he said. Lack of insurance is another major factor. The total cost of treating the nation's uninsured population is estimated at $65 billion to $130 billion annually, the reports said.

Expansion of health insurance coverage to an estimated 32 million Americans under the health system reform law is expected to help, but it will take awhile for increased access to care to translate into better quality care across populations, Dr. Moy said.

"Quality of care improvements take a long time to develop," he said.

This article has been modified since it was originally published.