Disparities in health care have been well documented: Nonwhites have higher rates of infant mortality, death from heart disease, incidence of diabetes and HIV/AIDS and are less likely to receive appropriate immunization than are whites. A recent study in the Journal of Racial and Ethnic Disparities indicates that between 1991 and 2000, five times as many lives could have been saved by ending health disparities than were saved by innovations in health technology over the same period.
Toward A High Performance Health System: Public-Private Efforts to Make Health Care Safer and More Effective
The U.S. health care system is the most expensive in the world. Yet it is clear that by many measures, Americans are not receiving commensurate value for the health care dollars they spend. Is it possible to simultaneously improve health coverage and quality, while generating savings for health care consumers, employers, government and health care providers? What are the characteristics of a high performance health system? What realistic steps does the private sector need to take, contrasted with government bodies, to move the U.S. toward such a system? What policy changes would be most helpful to the most vulnerable populations – the uninsured, and those facing disparities in care or coverage due to income, race/ethnicity, health or age?
With New Orleans largely evacuated and hundreds of thousands of people separated from their regular health care providers, how will Hurricane Katrina’s evacuees attend to their health and health care needs?
“Cash and Counseling” is a way of allowing individuals receiving personal assistance services through Medicaid to have more control over the services they get and who provides them. The program provides an individualized allowance that beneficiaries can use to hire a personal care assistant of their choice – often a family caregiver – or purchase items that help them live independently, such as chair lifts.
The 2004 election featured debates on major health issues including costs, access, and affordable prescription drugs. These issues will likely be subjects of continued focus during the upcoming Congress.
The Olmstead Decision Five Years Later: How Has It Affected Health Services and the Civil Rights of Individuals with Disabilities?
For decades, it was routine in the U.S. to house individuals with disabilities in institutions. Those with mental illnesses, for instance, were placed in “insane asylums,” as they were once called. The U.S. Supreme Court took a firm step toward ending this practice five years ago. In the Olmstead v. L.C. decision, the court found that institutional isolation of individuals with disabilities was, under certain circumstances, a violation of the Americans with Disabilities Act.
Low-income Medicare beneficiaries are a vulnerable population because of their disproportionately high medical and long-term care needs. Among low-income beneficiaries are nearly seven million individuals who are considered “dual-eligibles,” with coverage from both Medicare and Medicaid. They represent around one in six Medicare beneficiaries and one in seven Medicaid beneficiaries.
National polls and opinion surveys consistently show that health care is an important issue for voters. In a June 2003 survey by Harris Interactive, health care ranked third after economy/jobs and war/defense as an issue needing government action. A Gallup poll in September 2003 found that 85 percent of respondents considered presidential candidates’ positions on health care issues to be either extremely important or very important in influencing their votes.
Having health insurance, more than any other factor, determines how soon a person will get needed health care and whether that care will be the best available. Unfortunately, minorities have much lower rates of insurance coverage compared with whites. African Americans, for example, are almost twice as likely as whites to be uninsured. Hispanics/Latinos are almost three times as likely to lack coverage.
But even when coverage is equal, disparities in care persist. Minorities tend to receive lower quality care than non-minorities, have less access to specialty care, and experience more difficulties when communicating with health care providers.
What can be done to narrow the disparity gap? What measures are being taken to improve minorities’ access to health services and their quality? How do we raise awareness in the provider community about these disparities? How do we improve communication between minority patients and non-minority providers? How do we increase the number of minority health providers?
To help address these and related questions, the Alliance for Health Reform sponsored an October 10, 2003 briefing with support from the Robert Wood Johnson Foundation. Panelists were: Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation; Carolyn Clancy, director of the Agency for Healthcare Research and Quality; and Reed Tuckson, a senior vice president at UnitedHealth Group and an Alliance board member. Ed Howard of the Alliance moderated the discussion.
At the briefing, a new Alliance publication was released entitled Closing the Gap: Racial and Ethnic Disparities in Health Care. The brief was written by Brian Smedley, co-author of Unequal Treatment,a report by the Institute of Medicine on disparities in care with recommended solutions.
The number of uninsured Americans is one important measure of how serious a problem the lack of health coverage is. But counting the uninsured is harder than it sounds. While Census Bureau estimates of the uninsured are the most widely quoted (41.3 million in 2001), Americans who lack health insurance are a constantly changing group. They may lose coverage when they are laid off, shift employers, no longer qualify for public insurance programs or go through divorce or the death of a covered spouse. Then many regain it.
Numerous comparisons have been made between the rates of spending growth in Medicare and private health insurance. Many believe that private sector innovations present opportunities for constraining Medicare costs. Nonetheless, recent research looking at the past 30 years concludes that Medicare spending growth has been similar to the private sector, and at times even slower. Figures from the Centers for Medicare and Medicaid Services show Medicare cost growth was lower than that of private insurance in 2000 and 2001. Some of the difference may be attributed to the fact that private insurance, unlike Medicare, usually covers outpatient prescription drugs, one of the fastest-growing segments of health care. Moreover, some analysts say that Medicare’s relative success in controlling costs has been at the expense of quality and access.
The conditions in which people are born, grow, live, work, and age that affect their health.