Racial and Ethnic Disparities in the Quality of Health Care

Abstract

The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

Do racial and ethnic disparities in health care use vary with health?

“…Specifically, we find that, with regard to initial access to ambulatory care, the largest racial and ethnic differences in the probability of having an ambulatory care visit occur among adults in excellent health, and that the differences are significantly smaller when health is poor/fair. Consistent with the previous literature, we find that insurance coverage matters . Disparities across all levels of health were smaller among those with either private or public coverage compared to the uninsured.…”

“…The literature suggests many factors that contribute to racial and ethnic disparities. These factors range from differences in underlying health and treatment needs, health insurance coverage, and socioeconomic status (SES) to cultural factors and attitudes to discrimination . We focus on two key factors, in particular: health status and health insurance coverage.…”

“…Many disparities diminish or disappear altogether with coverage. For example, Fiscella and Sanders note that “differences in cancer screening by race or ethnicity among persons with similar types of insurance are relatively small.” On other measures of health care use, substantial disparities remain among even insured populations …”

Albuminuria Testing by Race and Ethnicity among Patients with Hypertension with and without Diabetes

“…Furthermore, data from the 2015 National Impact Assessment of Quality Measures Report identified several improvements in racial/ethnic disparities upon the implementation of HEDIS measures. These included kidney function testing for members with diabetes, cholesterol screening for patients with heart disease, breast cancer screening in women aged 52-69, and several others [23]. Since UACR testing is important for CKD identification and for accurate CKD staging, perhaps greater and more universal UACR testing would result if it were considered a quality measure among individuals with HTN, regardless of diabetes status.…”

Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature

“…Healthcare organisations have developed policies; workforce education and training programs; audit, monitoring and quality improvement practices; and culturally tailored programs and services [6, 15, 22–28]. Despite some healthcare organisations being responsive to the cultural and linguistic needs of their client populations, the required financial investments and failure to recognise the potential benefits mean that some organisations do not implement cultural competence interventions [13].…”