STRATEGIC PLAN - ASPE - U.S. Department of Health and Human ...

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CHAPTER 2: Health careReducing Health DisparitiesThe United States health care delivery systemencompasses outstanding providers, facilities, andtechnology. Many Americans enjoy easy access to care.However, not all Americans have full access to highqualityhealth care.The National Healthcare Disparities Report (2006Disparities Report), published annually by the Agencyfor Healthcare Research and Quality (AHRQ), providesa comprehensive national overview of disparities inhealth care in America and tracks the Nation’s progresstoward the elimination of health care disparities. xviMeasures of health care access are unique to this reportand encompass two dimensions of access: facilitatorsand barriers to care, and health care utilization.Three key themes are highlighted for those who seekinformation to improve health care services for allAmericans:• Disparities remain prevalent;• Some disparities are diminishing, while others areincreasing; and• Opportunities for reducing disparities remain.HHS is undertaking numerous initiatives aimed atreducing health care disparities and improving overallhealth care quality. These include, for example:• Activities coordinated by OCR, OPHS, and theHHS Disparities Council;• AHRQ’s “ Asthma Care Quality Improvement: AResource Guide for State Action”;• AHRQ’s “ Diabetes Care Quality Improvement: AResource Guide for State Action,” which providesbackground information on why States shouldconsider diabetes as a priority for State action,presents analysis of State and national data andmeasures of diabetes quality and disparities, andgives guidance for developing a State quality improvementplan;• AHRQ’s “State snapshots” of data, which are madeavailable to State officials and their public sectorand private sector partners to understand healthcare disparities;• AHRQ’s national health plan learning collaborativeto reduce disparities and improve diabetes care;• CDC’s National Breast and Cervical Cancer EarlyDetection Program;• CMS’s Hospital, Nursing Home, Home Health, andEnd Stage Renal Disease Quality Initiatives;• HRSA’s C.W. Bill Young Cell TransplantationProgram and National Cord Blood Inventory toincrease access to sources of high-quality bloodstem cells for transplantation for patients withouta suitable related blood stem cell donor;• HRSA’s Health Disparities Collaborative Initiative,which seeks to generate and document improvedhealth outcomes for underserved populations;• HRSA’s Healthy Start program, which works in97 communities with high annual rates of infantmortality to reduce disparities and improve healthoutcomes for mothers and infants from pregnancyto at least 2 years after delivery;• HRSA’s Maternal and Child Health Block Grant, aimedat improving care for all mothers and children; and• HRSA’s Organ Donation Collaborative, aimed atincreasing the number of organ donations andtransplants.Disparities PersistFindings in the 2006 Disparities Report are consistentwith those of previous reports: Disparities related torace, ethnicity, and socioeconomic status still pervadethe health care system, and are observed in almost allaspects of health care, including:• Across all dimensions of quality of care, includingeffectiveness, patient safety, timeliness, andpatient centeredness;• Across all dimensions of access to care, includingfacilitators and barriers to care and health careutilization;• Across many levels and types of care, includingpreventive care, treatment of acute conditions,and management of chronic disease;• Across many clinical conditions, including cancer,diabetes, end stage renal disease, heart disease,HIV disease, mental health, substance abuse, andrespiratory diseases;• Across many care settings, including primary care,home health care, hospice care, emergency de-52 HHS Strategic Plan FY 2007-2012
CHAPTER 2: Health carepartments, hospitals, and nursing homes; and• Within many subpopulations, including women,children, older adults, residents of rural areas,and individuals with disabilities and other specialhealth care needs.Changes in DisparitiesFor racial and ethnic minorities, some disparities inquality of care are improving and some are worsening.Of disparities in quality experienced by Blacks orAfrican-Americans, Asians, American Indians andAlaska Natives, and Hispanics, 5 about a quarter wereimproving and about a third were worsening; twothirdsof disparities in quality experienced by poorpeople were worsening.Some examples of changes in differences related to thequality of health care follow:• From 2000–2003, the proportion of adults whoreceived care for illness or injury as soon as wanteddecreased for Whites but increased for Blacks or African-Americans.From 2000–2004, the rate of newAIDS cases remained about the same for Whitesbut decreased for Blacks or African-Americans.• From 1999–2004, the proportion of adults age65 and over who did not receive a pneumoniavaccine decreased for Whites but increased forAsians. From 1998–2004, the proportion of childrenages 19 to 35 months who did not receive allrecommended vaccines decreased somewhat forWhites but even more for Asians.• From 2000–2003, the proportion of adults whohad not received a recommended screening forcolorectal cancer decreased for Whites but increasedfor American Indians and Alaska Natives.From 2002–2003, the proportion of adults whoreported communication problems with providersdecreased somewhat for Whites but even more forAmerican Indians and Alaska Natives.• From 2001–2003, the rate of pediatric asthmahospitalizations remained the same for non-His-5 In this section, the terms used for specific racial and ethnicminorities are consistent with the categories used in the 2006Disparities Report. The 2006 Disparities Report officially uses theterm “Blacks or African Americans” in accordance with the Office ofManagement and Budget (OMB). “Asian” includes “Asian or PacificIslander” when information is not collected separately for eachgroup. For all measures, Blacks, Asians, and American Indians andAlaska Natives are compared with Whites; Hispanics are comparedwith non-Hispanic Whites; and poor individuals are compared withhigh-income individuals.•panic Whites but increased for Hispanics. From2001–2003, the proportion of children without avision check decreased somewhat for non-HispanicWhites but even more for Hispanics.From 2000–2003, the proportion of adults age 40and older who did not receive three recommendedservices for diabetes decreased substantially forhigh-income persons but less for poor persons.From 2001–2003, the proportion of children whoseparents reported communication problems withproviders remained about the same for high-incomepersons but decreased for poor persons.Opportunities for ImprovementAlthough some inequalities are diminishing, there aremany opportunities for improvement. For all groups,measures could be identified for which the group notonly received worse care than the reference group but forwhich this difference was getting worse rather than better.All groups had several measures for which theyreceived worse care and for which the difference wasgetting worse. For Blacks or African-Americans, Asians,and Hispanics, imbalances in health care deliveryinvolved all the following domains of quality that couldbe tracked: preventive services, treatment of acuteillness, management of chronic disease and disability,timeliness, and patient-centeredness. For AmericanIndians and Alaska Natives, these negative factorsappeared concentrated in the treatment of acute illnessand the management of chronic disease and disability.Hispanics and the poor faced many inequalities inaccess to care that were getting worse:• For Hispanics, not having health insurance and ausual source of care worsened; and• For the poor, not having a usual source of care andexperiencing delays in care worsened.Some disparities in quality of care were prominentfor multiple groups, such as colorectal cancerscreening, vaccinations, hospital treatment of heartattack, hospital treatment of pneumonia, services fordiabetes, children hospitalized for asthma, treatmentof tuberculosis, nursing home care, problems withtimeliness, and problems with patient-providercommunication.HHS Strategic Plan FY 2007-201253
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Appendix h: endnotesXXX.CDC. (2005)
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