National Healthcare Disparities Report - LDI Health Economist

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Health System Infrastructure n From 2005 to 2009, non-Hispanic Whites had significantly higher rates of occupational therapists than Hispanics (Figure 8.3). Whites had significantly higher rates than all other racial groups except Asians. n During this period, Whites had significantly higher rates of physical therapists than Blacks, AI/ANs, and people of other and multiple races. Asians, however, had a higher rate of physical therapists than Whites in all years. Non-Hispanic Whites had significantly higher rates than Hispanics in all years. n Also from 2005 to 2009, Whites had significantly higher rates of speech-language pathologists than all other racial groups. Also, in the NHQR: Chapter 8 n From 2005 to 2009, the Northeast had a higher rate of occupational therapists than the South and the West in all years. n The Northeast also had a significantly higher rate of physical therapists than all other regions in all years. Care Management Processes: Focus on the Health Care Safety Net Concern about growing physician and health workforce shortages has increased over the past decade. According to the Health Resources and Services Administration, by 2020, the United States will experience a shortage of about 100,000 physicians and 1 million nurses. ii In his seminal work on health care quality, Donabedian (1980) describes a robust health care “structure”—the setting or infrastructure supporting the delivery of care (e.g., hospitals, providers)—as necessary to ensure that processes of care contribute to good outcomes. Structural deficiencies in the United States health care delivery system resulting from shortages of providers, growing demand, and a high rate of uninsurance and underinsurance have contributed to unmet need and could result in increased morbidity and health care costs. Safety net providers play an integral role in relieving unmet need. As defined in a report sponsored by HRSA, the U.S. health care safety net is composed of “[t]hose providers that organize and deliver a significant level of health care and other health-related services to the uninsured, Medicaid, and other vulnerable populations” (IOM, 2010). Safety net providers act as a default system, or providers “of last resort,” by ensuring access to care for millions of Americans lacking medical coverage or provider access, regardless of education, social status, language competency, or ability to pay. The safety net includes many different types of providers, including public health departments, hospitals, and federally funded health centers (FFHCs). For the 50 million uninsured people and individuals with low income, safety net providers serve an essential function, eliminating financial barriers to care and enhancing access to services. This section includes measures that show how well the health care safety net is meeting the needs of the Nation’s vulnerable populations, particularly low-income populations and racial/ethnic subgroups. This section focuses on two types of safety net providers: FFHCs and hospitals. ii National Center for Health Workforce Analysis, http://bhpr.hrsa.gov/healthworkforce/index.html. Accessed August 15, 2011. 212 National Healthcare Disparities Report, 2011
Health System Infrastructure NEW Patients Using Federally Funded Health Centers FFHCs include health care organizations that receive a grant under Section 330 of the Public Health Service Act, including community health centers, migrant health centers, Health Care for the Homeless programs, and Public Housing Primary Care programs. These organizations typically render services to low-income populations, uninsured people, people with limited English proficiency, migrant and seasonal farmworkers, individuals and families experiencing homelessness, and public housing residents. To obtain Federal grant funding, these public and nonprofit organizations agree to provide a minimum set of services, including primary and preventive care, mental health, and dental services. Access to care is available to all persons, regardless of ability to pay. Charges for services rendered are based on a sliding scale, which is linked to patients’ family income. More than 19 million people visited an FFHC in 2010. Figure 8.4. Race, ethnicity, and income of patients receiving care in an FFHC, United States, 2010 Chapter 8 80 70 60 50 Percent 40 30 20 10 0 White Black Asian Native Hawaiian Pacific Islander AI/AN >1 Race Hispanic Language Other Than English Income At or Below Poverty Level Income 101-150% of Poverty Level Income 151-200% of Poverty Level Income >200% of Poverty Level Source: Health Resources and Services Administration, Bureau of Primary Health Care, Uniform Data System, 2010. Note: Racial groups shown are non-Hispanic. Data were obtained from 1,124 Section 330g grantee recipients. Patients with hypertension include those ages 18-85. Hypertension is determined to be controlled if the patient’s last blood pressure reading was less than 140/90. Patients with diabetes include those ages 18-75. Diabetes is determined to be controlled if the patient’s most recent HbA1c was 7% or less. n In 2010, approximately 64 percent of patients seen at an FFHC were White (Hispanics and non- Hispanics), and one-quarter were Black (Figure 8.4). n In 2010, more than one-third of FFHC patients were Hispanic and about one-quarter of patients were determined by the FFHC to be best served in a language other than English. n Almost three-quarters of patients seen in an FFHC in 2010 had income at or below the Federal poverty level. Also, in the NHQR: n Nearly 40% of patients seen at an FFHC were uninsured and another 40% had Medicaid. National Healthcare Disparities Report, 2011 213
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