Resources for additional information about racial and
ethnic disparities in health care

A new survey conducted by Princeton Survey Research Association for Aetna and the National Conference for Community and Justice documents the current state of public opinion on key elements of racial disparities in healthcare, the differences among racial and ethnic groups, and changes in these attitudes over time. A copy of the report is available at www.nccj.org.

According to a July 10, 2002, report by the Commonwealth Fund on a demonstration project involving eight managed care plans, health plans can and should collect data on disparities in quality of care for racial and ethnic minority groups, despite legal and practical concerns. The report, Developing a Health Plan Report Card on Quality of Care for Minority Populations, emphasizes the importance of racial and ethnic data collection as the key to improving quality and eliminating disparities in health care.

In Addressing Racial and Ethnic Barriers to Effective Health Care: The Need for Better Data, the authors contend that health plans can play a critical role in eliminating health disparities by developing and implementing viable data collection strategies. Barriers to data collection and strategies to overcome them are discussed. Arlene S. Berman et al, “Addressing Racial and Ethnic Barriers to Effective Health Care: The Need for Better Data,” Health Affairs, 21, no. 2 (May/June 2002).

On March 20, 2003, the National Academies’ Institute of Medicine released Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In Unequal Treatment, a panel of experts documents and explores how people of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. A copy of Unequal Treatment may be obtained from the National Academy Press website, www.nap.edu.

Eric C. Schneider, M.D., M.Sc., and colleagues from the Harvard School of Public Health and Harvard Medical School, conducted an observational study to assess racial disparities in the quality of care for enrollees in Medicare managed care health plans. For their study, Racial Disparities in the Quality of Care for Enrollees in Medicare Managed Care, the authors used the 1998 Health Plan Employer Data and Information Set (HEDIS), which summarized performance during the 1997 calendar year for four measures of quality of care: breast cancer screening, eye examinations for patients with diabetes, use of beta blockers (a type of heart drug) after heart attack, and follow-up after hospitalization for mental illness. Journal of the American Medical Association, Vol. 287, No. 10, March 13, 2002.

An October 18, 2001, report from The Commonwealth Fund finds wide gaps between the goals of federal initiatives to eliminate racial and ethnic disparities in health care. The Commonwealth Fund, in partnership with the Summit Health Institute for Research and Education, and the National Health Law Program, conducted a survey of the statutes, regulations, policies and procedures of federal agencies to identify when the collection and reporting of data on race, ethnicity and primary language are required. The report, Racial, Ethnic and Primary Language Data Collection in the Health Care System: An Assessment of Federal Policies and Practices, delineates the context in which health-related data collection and reporting takes place at the federal level, particularly within the U.S. Department of Health and Human Services.

In November 2000, AHRQ published a special issue of Medical Care Research and Review, which includes several articles that explore different aspects of racial and ethnic disparities in health care. The articles discuss health insurance status, access and the use of health care services and cultural competency. The three articles in Medical Care Research and Review, Vol. 57 Supplement 1, (November 2000) are “Race/Ethnicity and Health Insurance Status”; “Racial and Ethnic Differences in Access to and Use of Health Care Services”; and “Can Cultural Competency Reduce Racial and Ethnic Disparities? A Review and Conceptual Model.”

As of July 2000, the National Committee for Quality Assurance began evaluating the cultural competency of a managed care organization’s physician network. The NCQA standard states that “managed care organizations must consider the consumer’s perception of the cultural competence of the organization. In demonstrating cultural competence, the organization must ensure that its provider panels can meet the racial, ethnic, cultural and linguistic needs and preferences of the member population.” As a result, managed care organizations will be evaluated on their ability to link members with physicians who can meet the race, ethnicity and language preferences of its members.

In 2003, the Centers for Medicare & Medicaid Services (CMS) began reviewing participating plans for either demonstrated reductions in clinical health care disparities for minority populations or improvements in the provision of culturally and linguistically appropriate services.

In 1998, the U.S. Department of Health and Human Services announced a national initiative designed, in part, to end disparities in various areas of health status experienced by racial and ethnic minority populations. This initiative has resulted in the articulation of goals and objectives that are now outlined in Healthy People 2010. HHS has set a national goal of eliminating, by 2010, longstanding disparities in health status between Caucasian Americans and minorities in six key health areas: infant mortality; cancer screening and management; cardiovascular disease; diabetes; HIV/AIDS rates; and child and adult immunization levels. Online information resources for the initiative are located at health.gov/healthypeople.