National Healthcare Disparities Report - LDI Health Economist

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Highlights to have high health care expenses. Of individuals who report that they were unable to get or delayed in getting needed medical care, dental care, or prescription medicines, two-thirds indicate a financial or insurance cause of the problem. Hispanics and non-Hispanic Blacks are more likely than non- Hispanic Whites to report a financial or insurance problem. n Usual source of care: Of individuals without a usual source of care, 18% indicate a financial or insurance reason for not having one. Poor individuals are five times as likely as high-income individuals and Hispanics are twice as likely as non-Hispanic Whites to report financial and insurance reasons for not having a usual source of care. n Inappropriate medication use: Inappropriate medication use is wasteful of resources. Inappropriate medication use among older adults has been stable over time. In addition, no significant disparities among groups persist over the observed study period. n Potentially harmful preventive services with no benefit: A preventive service without benefit tracked in the NHQR and NHDR is prostate-specific antigen testing of men age 75 and over to screen for prostate cancer. During the time measured, there has been a slight increase in testing. n Potentially avoidable hospitalization costs: While not all potentially avoidable hospitalizations can be prevented, rates can be reduced through better primary care. In total, potentially avoidable hospitalizations cost Americans $26 billion in 2008. If rates could be reduced to the achievable benchmark rate (the rate achieved by the best performing State; see Chapter 1 for benchmarking methods), $11 billion could be saved per year. Examples of Initiatives Making Care More Affordable Federal: Individuals and small businesses buying health insurance often have few options. The Affordable Care Act creates State-based Health Insurance Exchanges that will lower costs and improve health care quality by creating a more transparent and competitive marketplace. Insurers in exchanges will provide information on price and quality, promoting competition. By pooling people together, exchanges will also give individuals and small businesses purchasing power similar to that of large businesses (HHS Press Office, 2011). State: As States face tightening budgets, some have reformed payment. Minnesota bundles payments for seven common “baskets of care” (Rosenthal, et al., 2010). Other States have begun to scrutinize health care costs, including costs associated with disparities. The Virginia Health Equity Report includes an examination of excess costs associated with different disparities. Metrics include direct costs of hospital care and indirect costs of morbidity and premature mortality. A key finding is that disparities cost Virginia huge sums of money each year (www.vdh.state.va.us/healthpolicy/2008report.htm). Provider: Intermountain Healthcare developed a system to alert labor and delivery charge nurses when medical indications do not support early elective induction and to cancel these procedures. Performance reports are also shared with obstetric providers. The program greatly reduced early elective induction as well as neonatal complication rates and saved $1.7 million over 5 years (HCIE #3161). Via Christi Health developed a telepharmacy program for 14 hospitals. The program allows offsite pharmacists to review medication orders and patient medical records via computer and authorize hospital pharmacy systems to dispense the medications. Pharmacists cover multiple hospitals simultaneously, expanding hours of pharmacy services. The program reduced order processing times and saves $1 million per year. 28 National Healthcare Disparities Report, 2011
Highlights National Priority: Increasing the Availability and Quality of Data Collected and Reported on Racial and Ethnic Minority Populations Identifying problems, targeting resources, and designing interventions all depend on reliable data. Unfortunately, data on underserved populations are often incomplete. Some data sources do not collect information to identify specific groups. Other data sources collect this information, but the numbers of individuals from specific groups included are too small to allow reliable estimates. The HHS Disparities Action Plan includes this priority as part of its goal to advance scientific knowledge and innovation. Progress in Disparities Data In the 2006 NHDR, we presented a chart showing the percentage of core quality measures for which an estimate that met our reliability criteria could not be generated for single-race Asians, Native Hawaiians and Other Pacific Islanders, AI/ANs, multiple-race individuals, Hispanics, and poor people. Except for one measure related to language assistance, all measures provided reliable estimates for Blacks, so they were not shown. iv Below we include the percentage of all quality measures in the 2011 reports for which a reliable estimate could not be generated for these same groups. Again, except for the one measure of language assistance, reliable estimates could be generated for Blacks for all other measures, so they are not shown. Figure H.16. Percentage of quality measures in the 2006 and 2011 reports for which a reliable estimate could not be generated Better Same Worse 100 3 6 2 7 2 80 16 Percent 60 40 26 23 24 20 20 0 16 12 Black vs. White (n=45) Asian vs. White (n=41) AI/AN vs. White (n=33) 18 18 7 Hispanic vs. NHW (n=45) Poor vs. High Income (n=36) Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native. iv The measure is the percentage of adults with limited English proficiency and a usual source of care who had language assistance. National Healthcare Disparities Report, 2011 29
Page 1: NATIONAL HEALTHCARE DISPARITIES REP
Page 4 and 5: Acknowledgments The NHQR and NHDR a
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Care Coordination Importance Chapte
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U.S. Department of Health and Human
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