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PROLOGUEThe Public-Sector Response To DisparitiesPROLOGUE: One might think that by now, surely everyone knows that some people in this country are receiving worse health care than others, and that those receiving less and poorer-quality care are often members of minority racial and ethnic groups. These problems are not new, although they are receiving renewed recognition and attention. The Institute of Medicine’s Unequal Treatment report came out in 2002, and the Agency for Healthcare Research and Quality released the first National Healthcare Disparities Report the following year, documenting measurable differences in the levels of care received by some populations, even as they reported improvements in some indicators. For example, vaccination rates for black and Hispanic children are lower than those for whites or Asians, while diabetes care and management are about the same for black and white adults. Access to care remains a serious obstacle for the 12.5 percent of the population that is Hispanic, with lack of health insurance, language barriers, and degrees of acculturation as major predictors. Racial and ethnic minorities are projected to constitute more than 30 percent of the U.S. population by 2030 and deserve equal access to and receipt of high-quality health care. How do we intend to deliver such care to all? Data collection is a key component of the government’s efforts to reduce disparities and improve health outcomes. Without the political will to provide universal health care, policymakers rely on the numbers to document the size of the problem, health care advocates brandish the numbers as evidence of system failure, and civil rights advocates use them to confirm that the system is failing too many Americans. Data collection alone isn’t going to improve health care quality, but expanded and more accurate data can pinpoint where the gaps are and provide the baseline for measuring change and improvement. The papers that follow offer recommendations for federal action broadly, and specifically through Medicare, and for individual states. As Nicole Lurie, Minna Jung, and Risa Lavizzo-Mourey outline in their paper, data collection is a critical component of the quality improvement framework that the federal government can apply to reducing health disparities. June Eichner and Bruce Vladeck challenge Medicare to live up to its historical responsibility to administer health care for more than forty million Americans, using its considerable clout as the largest U.S. payer. Ernest Moy, Elizabeth Dayton, and Carolyn Clancy discuss the challenges and hurdles associated with identifying and collecting comparable data used to document disparities in the National Healthcare Disparities Report. Finally, Amal Trivedi and his colleagues take a look at state-level efforts and resources targeted at reducing health disparities.
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