First, let’s understand what we are talking about when we talk about disparities in health and health care. They’re different. Disparities in health refers to illnesses that one population group has when compared to another. Sickle cell anemia, for example, is thought to be more prevalent among African Americans than Caucasians. Health care disparities refers to differences in access to health care services, the quality of care delivered to different population groups, and insurance coverage and other payment options offered to different groups. It’s not simply that different populations have different health issues or treatments; it’s that the same issue, services or health care needs are not the same across all populations. Wouldn’t you think that if someone in New York City was treated for heart failure in a specific way and it cost a specific amount of money that someone in rural West Virginia would have access to the same treatment for similar cost? But often that’s not the case.
The problem is that health care disparities are not about health. Social factors have an influence on health care services, and thus on health care disparities: socioeconomic status, education, geographic access, linguistic and cultural barriers, citizenship, sexual orientation and a host of other factors that do not have to do with health conditions but in fact lead to disparities in care. If you are poor, a member of a minority, do not speak English fluently, feel culturally isolated, are geographically isolated, the health care you receive may be suboptimal or poor.
The Federal government is making an effort to reduce or eliminate health care disparities, focusing on specific populations (people of color), low income groups, other vulnerable populations such as children, the elderly, women, people with special health needs and inner city dwellers. Obviously disparities are not fair and should be reduced from a social justice point of view. But health disparities are costly to all Americans in direct medical costs for inequities and also indirectly for lost work time, poor productivity and death. Making improvements in population health would improve the quality of care for everyone.
In 2011, the Department of Health and Human Services (HHS) developed a plan to eliminate racial and ethnic disparities in health care. The HHS Disparities Action Plan has the goal of achieving equal access to care for all Americans. The Accountable Care Act (ACA) also promotes health care equity and has focused on disparity reduction by increasing funding for cultural competence training and other educational materials, as well as promoting data collection and research. Importantly, the ACA also has increased insurance coverage options for low-income populations. The ACA includes public health initiatives and prevention programs, specifically targeted at underserved populations. The Centers for Disease Control and Prevention (CDC) offers grants to state, local and educational groups to provide interventions to reduce disparities, focusing on outreach efforts. The Centers for Medicare and Medicaid Services (CMS) has launched a program to deliver better care through Accountable Health Communities.
Even with all these efforts, eliminating health care disparities will take time. And in fact solutions are quite complicated because the problems involve a complex set of social, economic, environmental and individual factors. Although government programs, especially the ACA, has made some impact on the problem, as the population becomes increasingly diverse and as income gaps become increasingly larger, addressing the factors that contribute to disparities is more important now than ever. It will cost all of us in health quality and expense if we don’t.