Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-19T22:45:41.609Z Has data issue: false hasContentIssue false
  • English
  • Français

Reducing Racial, Ethnic, and Socioeconomic Disparities in Health Care: Opportunities in National Health Reform

Published online by Cambridge University Press:  01 January 2021

Marsha Lillie-Blanton ,
Saqi Maleque  and
Wilhelmine Miller
Get access Rights & Permissions [Opens in a new window]

Extract

As this nation embarks on new efforts to reform the U.S. health system, we face a critical unfinished agenda from the mid- 1960s: persistent racial, ethnic, and socioeconomic disparities in health and health care. Medicaid, Medicare, and Community Health Centers — public programs with very different legislative histories and financing mechanisms — were the first federally funded, nationwide efforts to improve health care access for low-income and elderly Americans. Members of racial and ethnic minority groups also greatly benefited from these efforts because recipients of federal funds, such as Medicare, were required to comply with the newly passed Civil Rights Act of 1964, which barred racial discrimination. Unquestionably, government played a major role in the gains in health care access that have occurred in the last half century. Yet today all Americans do not have the same opportunities for health, access to care, or quality of care when they receive it.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 36 , Issue 4 , Winter 2008 , pp. 693 - 702
Copyright
Copyright © American Society of Law, Medicine and Ethics 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Grossman, M., “On the Concept of Health Capital and Demand for Health,” Journal of Political Economy 80, no. 2 (1972): 223–255; Schoeni, R. F. and House, J. S. et al., eds., Making Americans Healthier: Social and Economic Policy as Health Policy (New York: Russell Sage Foundation, 2008).Google Scholar
Robert Wood Johnson Foundation, Overcoming Obstacles to Health: Report from the Robert Wood Johnson Foundation to the Commission to Build a Healthier America, February 2008, available at <http://www.rwjf.org/files/research/obstaclestohealth.pdf> (last visited August 22, 2008) [hereinafter cited as RWJ Foundation]; Poverty guidelines for the 48 contiguous states and the District of Columbia for 2008 are as follows: $10,400 for 1 person household, $14,000 for 2-person household, and $17,600 for a 3-person household. Department of Health and Human Services, “Annual Update of the HHS Poverty Guidelines,” Federal Register 73, no. 15 (2008): 3971–3972.+(last+visited+August+22,+2008)+[hereinafter+cited+as+RWJ+Foundation];+Poverty+guidelines+for+the+48+contiguous+states+and+the+District+of+Columbia+for+2008+are+as+follows:+$10,400+for+1+person+household,+$14,000+for+2-person+household,+and+$17,600+for+a+3-person+household.+Department+of+Health+and+Human+Services,+“Annual+Update+of+the+HHS+Poverty+Guidelines,”+Federal+Register+73,+no.+15+(2008):+3971–3972.>Google Scholar
Id.Google Scholar
Bezruchka, S. et al., “Improving Economic Equality and Health: The Case of Postwar Japan,” American Journal of Public Health 98, no. 4 (2008): 589–594; The John, D. and Catherine, T. MacArthur Foundation, Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the U.S., 2007; see RWJ Foundation, supra note 2; The National Association of City and County Health Officials (NACCHO), Tackling Health Inequalities through Public Health Practice: A Handbook for Action (Washington, D.C.: W. K. Kellogg Foundation, 2006).Google Scholar
Krieger, N. et al., “Painting a Truer Picture of US Socioeconomic and Racial/Ethnic Health Inequalities: The Public Health Disparities Geocoding Project,” American Journal of Public Health 95, no. 2 (2005): 312–323.CrossRefGoogle Scholar
Mackenbach, J. P., Meerding, W. J., Kunst, A. E., “Economic Implications of Socio-economic Inequalities in Health in the European Union,” European Communities Health and Consumer Protection Directorate-General, 2007; Dow, W. and Schoeni, R. F., “Economic Value of Improving the Health of Disadvantaged Americans,” Technical Report for RWJ Foundation, supra note 2, available at <http://www.commissiononhealth.org/Publications.aspx> (last visited September 4, 2008); Muennig, P. and Woolf, S. H., “Health and Economic Benefits of Reducing the Number of Students per Classroom in US Primary Schools,” American Journal of Public Health 97, no. 11 (2007): 2020-2027.Google Scholar
Smedley, B. D., Stith, A. Y. and Nelson, A. R. eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, D.C.: National Academies Press, 2003).Google Scholar
Burstin, H. et al., “Socioeconomic Status and Risk for Sub-standard Medical Care,” JAMA 268, no. 17 (1992): 2383–2387; Haas, J. and Adler, N., “The Causes of Vulnerability: Disentangling the Effects of Race, Socioeconomic Status and Insurance Coverage on Health,” Background Paper prepared for the IOM Committee on the Consequences of Uninsurance, 2001.CrossRefGoogle Scholar
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2007.Google Scholar
Weinick, R. M. and Beauregard, K. M., “Women's Use of Preventive Screening Services: A Comparison of HMO Versus Free-for-Service Enrollees,” Medical Care Research and Review 54, no. 2 (1997): 176–199; Cox, C. M. et al., “Insurance or Regular Physician: Which Is the Most Powerful Predictor of Health Care?” American Journal of Public Health 93, no. 5 (2003): 786-791; Lambrew, J. M. et al., “The Effects of Having a Regular Doctor on Access to Primary Care,” Medical Care 34, no. 2 (1996): 138-151; and Devore, J. E. et al., “Receipt of Preventive Care Among Adults: Insurance Status and Usual Source of Care,” American Journal of Public Health 93, no. 5 (2003): 786-791.CrossRefGoogle Scholar
McGlynn, E. A. et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine 348, no. 26 (2003): 2635–2645; Asch, et al., “Who Is at Greatest Risk for Receiving Poor-Quality Health Care?” New England Journal of Medicine 354, no. 11 (2006): 1147-1155.CrossRefGoogle Scholar
Cunningham, W. E. et al., “Prevalence and Predictors of Highly Active Antiretroviral Therapy Use in Patients with HIV Infection in the US,” Journal of Acquired Immune Deficiency Syndrome 25, no. 2 (2000): 115–123; Cunningham, W. E. et al., “The Effect of Socioeconomic Status on the Survival of People Receiving Care for HIV Infection in the United States,” Journal of Health Care for the Poor and Underserved 16, no. 4 (2005): 655-676.CrossRefGoogle Scholar
Morris, C. R. et al., “Increasing Trends in the Use of Breast-Conserving Surgery in California,” American Journal of Public Health 90, no. 2 (2000): 281–284; Hawley, S. T. et al., “Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?” Health Services Research 43, no. 4 (2008): 1-22.Google Scholar
Canto, J. G. et al., “Payer Status and the Utilization of Hospital Resources in Acute Myocardial Infarction,” Archives of Internal Medicine 160, no. 6 (2000): 817–823; Cutler, D. M. and McClellan, M., “Is Technological Change in Medicine Worth It,” Health Affairs 20, no. 5 (2001): 11-29; Glied, S. and Little, S. E., “The Uninsured and the Benefits of Medical Progress,” Health Affairs 22, no. 4 (2003): 20-219.CrossRefGoogle Scholar
Kaiser Family Foundation, Health Insurance in America: 2006 Data Update, October 2007, available at <http://www.kff.org/uninsured/upload/2006_DATA%20_UPDATE.pdf> (last visited August 22, 2008).+(last+visited+August+22,+2008).>Google Scholar
Id.Google Scholar
Id.Google Scholar
Institute of Medicine, Care Without Coverage: Too Little Too Late (Washington, D.C.: National Academies Press, 2003); Hadley, J., “Sicker and Poorer — The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income,” Medical Care Research and Review 60, no. 2 (2003): 3S-75S; Ayanian, J. Z. et al., “The Relation Between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer,” New England Journal of Medicine 284, no.16 (2000): 2061-2069; Baker, D. W. et al., “Lack of Health Insurance and Decline in Overall Health in Late Middle Age,” New England Journal of Medicine 345, no. 15 (2001): 1106-1112.Google Scholar
Rhodes, J. A. and Cohen, S. B., “The Long Term Uninsured in America, 2002–2005: Estimates for the U.S. Population under Age 65,” Agency for Health Care Research and Quality, Statistical Brief #183, 2007, available at <http://www.meps.ahrq.gov/mepsweb/data_files/publications/st183/stat183.pdf> (last visited August 22, 2008).+(last+visited+August+22,+2008).>Google Scholar
Rhodes, J. A., “The Long Term Uninsured in America, 2003 to 2004: Estimates for the U.S. Population under Age 65,” Agency for Health Care Research and Quality, Statistical Brief #140, 2006, available at <http://www.meps.ahrq.gov/mepsweb/data_files/publications/st140/stat140.pdf> (last visited August 22, 2008).Google Scholar
See National Healthcare Disparities Report, supra note 9, at iv.Google Scholar
Institute of Medicine, A Shared Destiny: Community Effects of Uninsurance (Washington, D.C.: National Academy Press, 2004).Google Scholar
Pagan, J. A. and Pauly, M. V., “Community-Level Uninsurance and the Unmet Medical Needs of Insured and Uninsured Adults,” Health Services Research 41, no. 3, Part I (2006): 788–803.CrossRefGoogle Scholar
United States Government Accountability Office, Health Professional Shortage Areas: Problems Remain with Primary Care Shortage Area Designation System, October 2006, available at <http://www.gao.gov/new.items/d0784.pdf> (last visited August 22, 2008).+(last+visited+August+22,+2008).>Google Scholar
Gaskin, D. J. and Hadley, J., “Population Characteristics of Markets of Safety-Net and Non-Safety-Net Hospitals,” Journal of Urban Health: Bulletin of the New York Academy of Medicine 76, no. 3 (1999): 351–70.CrossRefGoogle Scholar
The Commonwealth Fund, Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans: Findings from the Commonwealth Fund 2001 Health Care Quality Survey, March 2002, available at <http://www.commonwealthfund.org/usr_doc/collins_diversecommun_523.pdf?section=4039> (last visited August 22, 2008).+(last+visited+August+22,+2008).>Google Scholar
Lillie-Blanton, M. et al., “Site of Medical Care: Do Racial and Ethnic Differences Persist?” Yale Journal of Health Policy, Law, and Ethics 1 (2001): 15–32.Google Scholar
Rothenberg, B. M. et al., “Explaining Disparities in Access to High-Quality Cardiac Surgeons,” The Annals of Thoracic Surgery 78, no. 1 (2004): 18–24.CrossRefGoogle Scholar
Saha, S. and Shipman, S. A., “Race-Neutral Versus Race-Conscious Workforce Policy to Improve Access to Care,” Health Affairs 27, no. 1 (2008): 234–245.CrossRefGoogle Scholar
Id.; Sullivan Commission, Missing Persons: Minorities in the Health Professions: A Report of the Sullivan Commission on Diversity in the Healthcare Workforce, September 2004, available at <http://minority-health.pitt.edu/archive/00000040/01/Sullivan_Final_Report_000.pdf> (last visited August 22, 2008).+(last+visited+August+22,+2008).>Google Scholar
Cooper-Patrick, L. et al., “Race, Gender, and Partnerships in the Patient-Physician Relationship,” JAMA 282, no. 5 (1999): 583–589; Komarony, M. et al., “The Role of Black and Hispanic Physicians in Providing Health Care for Underserved Populations,” New England Journal of Medicine 334, no. 20 (1996): 1305-1310.Google Scholar
Department of Health and Health Services, Office of Minority Health, A Strategic Framework for Improving Racial/Ethnic Minority Health and Eliminating Racial/Ethnic Health Disparities, March 2008.Google Scholar
Chin, M. et al., “Interventions to Reduce Racial and Ethnic Disparities in Health Care,” Medical Care Research and Review 64, no. 5 (2007): 7s–28s.CrossRefGoogle Scholar
National Health Plan Collaborative, Phase One Summary Report: Reducing Racial and Ethnic Disparities & Improving Quality of Health Care AHIP, November 2006, available at <http://www.chcs.org/NationalHealthPlanCollaborative/images/641_104_NHCP_summary_V3.pdf> (last visited August 22, 2008); HRSA Bureau of Primary Care, “Health Disparity Collaboratives,” available at <http://www.health-disparities.net/hdc/html/home.aspx> (last visited August 22, 2008); Nerenz, D. R., “Health Care Organizations' Use of Race/Ethnicity Data to Address Quality Disparities,” Health Affairs 24, no. 2 (2005): 409–416; Chin, M. et al., “Improving Diabetes Care in Midwest Community Health Centers with the Health Disparities Collaborative,” Diabetes Care 27, no. 8 (2004): 2-8.CrossRefGoogle Scholar
Hassett, P., “Taking On Racial and Ethnic Disparities in Health Care: The Experience at Aetna,” Health Affairs 24, no. 2 (2005): 417–420.CrossRefGoogle Scholar
See National Healthcare Disparities Report, supra note 9.Google Scholar