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Healthcare Disparities Persist

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WASHINGTON, Oct 13, 2003 (United Press International via COMTEX) -- Public awareness, better databases, the Internet and local communities all can contribute to reducing disparities in healthcare -- differential treatment based on race, ethnicity, income or education.

A new briefing from the Alliance for Health Reform, of Washington, suggests patients and healthcare providers are not aware of the magnitude of the problem, despite a large and growing body of scientific evidence.

"The way to really make a difference, in part, we believe, is by focusing on quality," said Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation of Princeton, N.J., which financially supported the project. "Quality really is what we all want and deserve when we think of the healthcare system."

A national poll commissioned in August by the Harvard Forums on Health finds 52 percent of whites thought people of different races and ethnic backgrounds receive equal healthcare. Two-thirds of African-Americans surveyed felt minority patients received lower quality care than whites and Hispanics were almost equally divided on the issue.

The Alliance report also said about 70 percent of physicians surveyed thought minorities are "rarely" or "never" treated unfairly in the healthcare system. Yet Ed Howard of the Alliance said "racism in healthcare is not some distant memory -- disparities, in short persist." He noted recently in Pennsylvania a hospital administrator apologized for going along with a husband's request that no African-Americans assist in the delivery of his child.

New research shows, overall, African-Americans tend to receive lower quality healthcare than whites for everything from cancer, heart disease and HIV/AIDS to diabetes and mental health. There is not as much evidence yet examining disparities involving Hispanics and other ethnic groups.

Brian Smedley, who wrote the Alliance briefing and is co-author of "Unequal Treatment," a 2002 report by the Institute of Medicine on healthcare disparities, said it is impossible to assign a "weight" to how much general bigotry plays a part in disparate healthcare treatment, even among providers who have no racist tendencies and want to give the best care for all patients.

Smedley said the indications showing it as a societal and institution problem are "significant" and "those of us who are unintentioned can't help but be aware of stereotypes" that affect actions even at an unconscious level.

Congress is addressing the disparity problem by mandating the Agency for Healthcare Research and Quality report each year on the latest data.

"We have a long way to go to improve the quality of care provided," said AHCR director Carolyn Clancy. She added disparities are not just about race and ethnicity -- income and education also are very important factors.

For example, data show the rates of avoidable hospitalizations, from such causes as flu or pneumonia, are much higher in neighborhoods of low-income residents or with lower education levels. There also appears to be a direct link between a patient's inability to communicate -- whether in English or some other native language -- and quality of care.

The IOM recommended solutions to the disparity problem that included using evidence-based medicine -- looking at what really works in determining treatment -- awarding providers who consistently give high quality care, and removing language barriers.

The Alliance report also said data show black and other ethnic patients with the same levels of health insurance as whites still receive lesser amounts and a lower quality of care. Being uninsured also reduces access to care for minorities and ethnic populations disproportionately.

Reed Tuckson, senior vice president at UnitedHealth Group of Minnetonka, Minn., the nation's largest private insurer, said data collected by insurance companies can help identify and quantify the problem -- and potentially help solve it.

"We have so much more that we can extract from companies like mine and those in the provision of health insurance," he said.

Data and the Internet are crucial, he said, to making sure minority and ethnic groups receive equal and appropriate healthcare.

Part of the solution is having disease management programs in place within the healthcare system and part is having data immediately available on a healthcare provider's computer screen, pointing out a patient's history and medical needs, as well as barriers to care, such as language difficulties, so ongoing treatment is coordinated.

"Then this must support better decision making and empowerment," Tuckson said. "The Internet, I think, is going to be very important. ... Everything we can do to enhance Internet services for people of color is essential."

Data also will help patients and physicians measure performance and make decisions, Tuckson said.

"Most doctors want to do the right thing, but because of databases we can measure actual performance of the doctor and of the hospital, he said. "We will increasingly see now an ability to say to the patient, 'Here is the performance of that hospital and how well it manages your disease, people in your socio-economic class, people like you. Here (are) the data that allows you to make a decision going forward.'"

Tuckson said other solutions include working with employers to pinpoint problems. For example, he said UnitedHealth's study of middle management black or ethnic workers finds they had a "very disturbing" rate of disease indices compared to their white counterparts.

Clancy said two upcoming AHCR reports will address disparities and quality in health care as well as patient experiences within the healthcare system. Priority areas will include cancer, kidney and heart disease, AIDS/HIV, pregnancy, asthma, flu, nursing homes, home health and patient safety.

Because improvements in healthcare quality really are local issues, she said she hoped the reports would provide a template for local communities to understand how care is provided in their communities.

"The information we're going to be producing is at a national level but at the end of the day folks need to know what's going on at the local level," Clancy said. High risk groups can then be identified locally and their quality of care improved.

Sen. Bill Frist, R-Tenn., who also is a physician, has introduced the "Closing the Health Care Gap Act of 2003," which calls for a health care access and promotion grant program for local health care services and community resources. Eligible grantees would include faith-based institutions and community health centers. Eligible programs would be those that built community infrastructures that promote effective healthcare coordination and management.

The Department of Health and Human Services this past week awarded $65.1 million for health disparities research and the elimination of health disparities among racial and ethnic minority and medically underserved communities.

Some $20 million went to four institutions for disparities research and $32 million was given to 33 biomedical and behavioral research outlets.

Copyright 2003 by United Press International.

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