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 — Posted May 7, 2012

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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.

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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)

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External links

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

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