Implementing Health Reform: Improved Data Collection and the Monitoring of Health Disparities

Dorsey, Rashida; Graham, Garth; Glied, Sherry; Meyers, David; Clancy, Carolyn M.; Koh, Howard K.

doi:10.1146/annurev-publhealth-032013-182423

Cited by 28 publications

(26 citation statements)

References 50 publications

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“…In the USA, a lack of valid and reliable standards for the collection of data to categorize racial/ethnic minority groups has hindered uniform reporting and tracking of health disparities [23]. The ACA requires all federally funded health programs to collect data on race, ethnicity, primary language, and disability status [18] (Section 3101).…”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update

Sealy-Jefferson

Vickers

Elam

et al. 2015

J. Racial and Ethnic Health Disparities

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Persistent racial and ethnic health disparities exist in the USA, despite decades of research and public health initiatives. Several factors contribute to health disparities, including (but not limited to) implicit provider bias, access to health care, social determinants, and biological factors. Disparities in health by race/ethnicity are unacceptable and correctable. The Patient Protection and Affordable Care Act is a comprehensive legislation that is focused on improving health care access, quality, and cost control. This health care reform includes specific provisions which focus on preventive care, the standardized collection of data on race, ethnicity, primary language and disability status, and health information technology. Although some provisions of the Patient Protection and Affordable Care Act have not been implemented, such as funding for the U.S. Public Health Sciences track, which would have addressed the shortage of medical professionals in the USA who are trained to use patient-centered, interdisciplinary, and care coordination approaches, this legislation is still poised to make great strides toward eliminating health disparities. The purpose of this manuscript is to highlight the unprecedented opportunities that exist for the Patient Protection and Affordable Care Act to reduce racial and ethnic disparities in health in the USA.

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Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update

Sealy-Jefferson

Vickers

Elam

et al. 2015

J. Racial and Ethnic Health Disparities

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show abstract

“…The Affordable Care Act (ACA) includes provisions aimed at increasing access to appropriate healthcare and eliminating disparities in access among vulnerable populations, including persons with disabilities. 8,75,76 In order to succeed, the ACA must enhance equity in access to healthcare and quality of care provided and align consumption of healthcare resources to achieve system efficiencies (e.g. increase use of primary care).…”

Section: Discussionmentioning

confidence: 99%

Health spending among working-age immigrants with disabilities compared to those born in the US

Tarraf

Mahmoudi

Dillaway

et al. 2016

Disability and Health Journal

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Background Immigrants have disparate access to healthcare. Disabilities can amplify their healthcare burdens. Objective/Hypothesis Examine how US- and foreign-born working-age adults with disabilities differ in their healthcare spending patterns. Methods Medical Expenditures Panel Survey yearly-consolidated files (2000-2010) on working-age adults (18-64 years) with disabilities. We used three operational definitions of disability: physical, cognitive, and sensory. We examined annual total, outpatient/office-based, prescription medication, inpatient, and emergency department (ED) health expenditures. We tested bivariate logistic and linear regression models to, respectively, assess unadjusted group differences in the propensity to spend and average expenditures. Second, we used multivariable two-part models to estimate and test per-capita expenditures adjusted for predisposing, enabling, health need and behavior indicators. Results Adjusted for age and sex differences, US-born respondents with physical, cognitive, sensory spent on average $2,977, $3,312, and $2,355 more in total compared to their foreign-born counterparts (P<0.01). US-born spending was also higher across the four types of healthcare expenditures considered. Adjusting for the behavioral model factors, especially predisposing and enabling indicators, substantially reduced nativity differences in overall, outpatient/office-based and medication spending but not in inpatient and ED expenditures. Conclusions Working-age immigrants with disabilities have lower levels of healthcare use and expenditures compared to their US-born counterparts. Affordable Care Act provisions aimed at increasing access to insurance and primary care can potentially align the consumption patterns of US- and foreign-born disabled working-age adults. More work is needed to understand the pathways leading to differences in hospital and prescription medication care.

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“…The data collected by HHS programs is essential to identify inequities and to develop and assess programs to reduce health disparities. Prior to the ACA standards, inconsistent or incomplete data limited our ability to track the status of health and health care within or for disadvantaged populations …”

Section: Policy and Politicsmentioning

confidence: 99%

“…Prior to the ACA standards, inconsistent or incomplete data limited our ability to track the status of health and health care within or for disadvantaged populations. 2 Standardized collection of disability data is particularly important because disability is not adequately captured through surveys or through medical and reimbursement records. HHS surveys have used inconsistent definitions of disability, targeted different populations, and omitted important questions about physical, programmatic, or attitudinal barriers.…”

mentioning

confidence: 99%

Collecting New Data on Disability Health Inequities

Pendo¹

2016

Hastings Center Report

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One of the goals of The Patient Protection and Affordable Care Act is the reduction and elimination of health inequities, generally defined as population‐level health differences that adversely affect disadvantaged groups. The ACA provides powerful new tools to collect, analyze, and share standardized data on these inequities. Prior to the ACA, disability was marginalized in data collection efforts, limiting our ability to understand and address significant health inequities experienced by millions of Americans. Now, for the first time, we can use these tools to collect valuable new data on the nature and extent of health inequities experienced by people with disabilities across the country. Standardized health data collection is critical to health equity.

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Implementing Health Reform: Improved Data Collection and the Monitoring of Health Disparities

Cited by 28 publications

References 50 publications

Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update

Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update

Health spending among working-age immigrants with disabilities compared to those born in the US

Collecting New Data on Disability Health Inequities

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