The United States health care delivery system encompasses outstanding providers, facilities, and technology. Many Americans enjoy easy access to care. However, not all Americans have full access to high-quality health care.
The National Healthcare Disparities Report (2006 Disparities Report), published annually by the Agency for Healthcare Research and Quality (AHRQ), provides a comprehensive national overview of disparities in health care in America and tracks the Nation’s progress toward the elimination of health care disparities.xvi Measures of health care access are unique to this report and encompass two dimensions of access: facilitators and barriers to care, and health care utilization.
Three key themes are highlighted for those who seek information to improve health care services for all Americans:
- Disparities remain prevalent;
- Some disparities are diminishing, while others are increasing; and
- Opportunities for reducing disparities remain.
HHS is undertaking numerous initiatives aimed at reducing health care disparities and improving overall health care quality. These include, for example:
- Activities coordinated by OCR, OPHS, and the HHS Disparities Council;
- AHRQ’s “Asthma Care Quality Improvement: A Resource Guide for State Action”;
- AHRQ’s “Diabetes Care Quality Improvement: A Resource Guide for State Action,” which provides background information on why States should consider diabetes as a priority for State action, presents analysis of State and national data and measures of diabetes quality and disparities, and gives guidance for developing a State quality improvement plan;
- AHRQ’s “State snapshots” of data, which are made available to State officials and their public sector and private sector partners to understand health care disparities;
- AHRQ’s national health plan learning collaborative to reduce disparities and improve diabetes care;
- CDC’s National Breast and Cervical Cancer Early Detection Program;
- CMS’s Hospital, Nursing Home, Home Health, and End Stage Renal Disease Quality Initiatives;
- HRSA’s C.W. Bill Young Cell Transplantation Program and National Cord Blood Inventory to increase access to sources of high-quality blood stem cells for transplantation for patients without a suitable related blood stem cell donor;
- HRSA’s Health Disparities Collaborative Initiative, which seeks to generate and document improved health outcomes for underserved populations;
- HRSA’s Healthy Start program, which works in 97 communities with high annual rates of infant mortality to reduce disparities and improve health outcomes for mothers and infants from pregnancy to at least 2 years after delivery;
- HRSA’s Maternal and Child Health Block Grant, aimed at improving care for all mothers and children; and
- HRSA’s Organ Donation Collaborative, aimed at increasing the number of organ donations and transplants.
Findings in the 2006 Disparities Report are consistent with those of previous reports: Disparities related to race, ethnicity, and socioeconomic status still pervade the health care system, and are observed in almost all aspects of health care, including:
- Across all dimensions of quality of care, including effectiveness, patient safety, timeliness, and patient centeredness;
- Across all dimensions of access to care, including facilitators and barriers to care and health care utilization;
- Across many levels and types of care, including preventive 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, and respiratory diseases;
- Across many care settings, including primary care, home health care, hospice care, emergency departments, hospitals, and nursing homes; and
- Within many subpopulations, including women, children, older adults, residents of rural areas, and individuals with disabilities and other special health care needs.
Changes in Disparities
For racial and ethnic minorities, some disparities in quality of care are improving and some are worsening. Of disparities in quality experienced by Blacks or African-Americans, Asians, American Indians and Alaska Natives, and Hispanics,5 about a quarter were improving and about a third were worsening; two-thirds of disparities in quality experienced by poor people were worsening.
Some examples of changes in differences related to the quality of health care follow:
- From 2000–2003, the proportion of adults who received care for illness or injury as soon as wanted decreased for Whites but increased for Blacks or African-Americans. From 2000–2004, the rate of new AIDS cases remained about the same for Whites but decreased for Blacks or African-Americans.
- From 1999–2004, the proportion of adults age 65 and over who did not receive a pneumonia vaccine decreased for Whites but increased for Asians. From 1998–2004, the proportion of children ages 19 to 35 months who did not receive all recommended vaccines decreased somewhat for Whites but even more for Asians.
- From 2000–2003, the proportion of adults who had not received a recommended screening for colorectal cancer decreased for Whites but increased for American Indians and Alaska Natives. From 2002–2003, the proportion of adults who reported communication problems with providers decreased somewhat for Whites but even more for American Indians and Alaska Natives.
- From 2001–2003, the rate of pediatric asthma hospitalizations remained the same for non-Hispanic Whites but increased for Hispanics. From 2001–2003, the proportion of children without a vision check decreased somewhat for non-Hispanic Whites but even more for Hispanics.
- From 2000–2003, the proportion of adults age 40 and older who did not receive three recommended services for diabetes decreased substantially for high-income persons but less for poor persons. From 2001–2003, the proportion of children whose parents reported communication problems with providers remained about the same for high-income persons but decreased for poor persons.
Opportunities for Improvement
Although some inequalities are diminishing, there are many opportunities for improvement. For all groups, measures could be identified for which the group not only received worse care than the reference group but for which this difference was getting worse rather than better.
All groups had several measures for which they received worse care and for which the difference was getting worse. For Blacks or African-Americans, Asians, and Hispanics, imbalances in health care delivery involved all the following domains of quality that could be tracked: preventive services, treatment of acute illness, management of chronic disease and disability, timeliness, and patient-centeredness. For American Indians and Alaska Natives, these negative factors appeared concentrated in the treatment of acute illness and the management of chronic disease and disability.
Hispanics and the poor faced many inequalities in access to care that were getting worse:
- For Hispanics, not having health insurance and a usual source of care worsened; and
- For the poor, not having a usual source of care and experiencing delays in care worsened.
Some disparities in quality of care were prominent for multiple groups, such as colorectal cancer screening, vaccinations, hospital treatment of heart attack, hospital treatment of pneumonia, services for diabetes, children hospitalized for asthma, treatment of tuberculosis, nursing home care, problems with timeliness, and problems with patient-provider communication.