Principles for Eliminating Racial and Ethnic Disparities in Health Care Under Healthcare Reform

Abstract

The elimination of racial and ethnic disparities in health has become a national priority in the United States (U.S. Department of Health and Human Services, Healthy people 2010: understanding and improving health, 2nd ed. Washington, DC: U.S. Government Printing Office, 2000). These disparities have many causes and potential solutions. In the landmark Unequal Treatment report, the Institute of Medicine reviewed and highlighted racial and ethnic disparities in health care as an important factor contributing to disparities in health outcomes (Institute of Medicine, Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, 2002). This report concluded with a strong call for action to eliminate racial and ethnic disparities in the US healthcare system. Since 2003, the federal government has issued an annual National Healthcare Disparities Report to monitor racial, ethnic, and socioeconomic disparities in access to care and quality of care. Whereas the initial report released by the federal Department of Health and Human Services generated considerable controversy and debate about the content and interpretation of key findings (Bloche, N Engl J Med 350(15):1568–70, 2004), subsequent reports have become a useful tool for tracking national trends in disparities across a wide array of quality measures. In 2004, this report found that lower quality of care was experienced by African Americans for two-thirds of measures, by Hispanics for one-half of measures, and by American Indians/Alaskan Natives for one-third of measures (Moy et al., Health Aff (Millwood) 24(2):376–87, 2005). In this chapter, five principles are presented to guide policy makers, health care leaders, and healthcare professionals seeking to reduce and ultimately eliminate racial and ethnic disparities in health care. These principles are based on clinical and policy experience, the research literature on healthcare disparities, and findings and recommendations of key reports from the Institute of Medicine (Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, 2002) and the American College of Physicians (Groman and Ginsburg, Ann Intern Med 141(3):226–32, 2004). The principles have been refined with input from an advisory committee of clinical and academic leaders in minority health care convened by the Minority Health Institute. The principles address aspects of access to care and quality of care that are especially important for minority populations in the United States, including African Americans, Latinos, Asian Americans, Native Hawaiians and other Pacific Islanders, and American Indians and Alaska Natives. These principles have become more timely and attainable with passage of the federal Patient Protection and Affordable Care Act (PPACA) that was enacted by Congress and signed by President Obama in March 2010.