A report by the Commonwealth Fund released this week found pervasive racial and ethnic inequities across all state health systems.
When it comes to policy changes that could help bridge the gap, report authors pointed to ensuring health coverage, investing in social services, reducing administrative burdens and improving service delivery – including via telemedicine and licensure modernization.
“With the recent rise in virtual care, I’m hopeful that soon your ZIP code will no longer decide the type or quality of healthcare you receive, no matter where you live,” said Dr. Ian Tong, chief medical officer at Included Health (formerly known as Doctor on Demand), in a statement about the report provided to Healthcare IT News.
WHY IT MATTERS
The report found that racial and ethnic disparities endure even in states that achieve high performance overall.
Authors pointed to Minnesota, for instance, as one example: Although it was ranked third in the Commonwealth Fund’s 2020 Scorecard on State Health System Performance, it has some of the largest disparities between communities of color and white communities.
Health outcomes – measured primarily by mortality rates and the prevalence of health-related problems – differ significantly based on race and ethnicity. Black and Native people are more likely to die from preventable causes than white, Hispanic and Asian people in nearly every state.
“While enduring lower life expectancies for Black and [American Indian/Alaska Native] individuals in the U.S. can be attributed in large part to generations of structural racism, oppression, and other factors beyond health care delivery, the healthcare system nevertheless has a crucial and often unfulfilled role in mitigating disparities,” wrote report authors.
The report zoomed in on treatable conditions with skewed outcomes: In nearly all states where data are available, Black and Native people are more likely to die from complications of diabetes. Black women are also more likely than white women to be diagnosed with breast cancer at later stages and to die.
Authors noted that access to affordable medical services via insurance coverage and primary care also remains an issue.
“Because of these costs, Black, Latinx/Hispanic, and [American Indian/Alaska Native] people are more likely to avoid getting care when they need it, more often have higher out-of-pocket costs, and are more prone to incur medical debt at all income levels,” read the report.
Tong, for his part, pointed to the need for a more diverse healthcare workforce.
“It should come as no surprise that people of color experience different and unequal treatment within the U.S. healthcare system. Most provider networks in the country lack the diversity needed to deliver truly culturally concordant and equitable care,” he said.
Report authors sorted what they saw as necessary policy changes into four categories:
- Ensuring universal, affordable and equitable health coverage, including by closing the Medicaid coverage gap, lowering immigration-related barriers to coverage and reducing out-of-pocket costs and deductibles for marketplace insurance
- Strengthening primary care and improving service delivery, such as by safeguarding access to telemedicine, allowing healthcare professionals to more easily practice across state lines and developing community-based workforces focused on team care
- Reducing inequitable administrative burdens affecting patients and providers, such as via autoenrollment and more seamless prior authorization
- Investing in social services, including economic support, childcare, food security and targeted wealth-building programs
“Given that structural racism has played a significant role in shaping those policies that have spawned widespread health inequities, leaders at the federal, state and local levels should reexamine existing laws and regulations for their impact on people of color’s access to quality care,” wrote report authors. “And new reforms to ensure good insurance coverage and timely access to primary and specialty care need to target communities across the United States that have long been ignored.”
“Equally important is the development and use of equity-focused measures to monitor the progress of efforts intended to advance health equity and to engender accountability for achieving desired outcomes,” they added.
They also raised imperatives around data-gathering and -sharing: “Systems are needed to track whether states, health systems and health plans are reducing racial disparities in clinical outcomes, coverage, access to clinicians and a host of other health-related gaps.”
THE LARGER TREND
Researchers and experts have pointed to the role digital health tools can play in equity – but cautioned that technology can, at times, be a double-edged sword.
For instance, telehealth can be used to more effectively reach patients who face transit-related hurdles to care or who can’t take time off work to go to the doctor, but it also may be unavailable to individuals who can’t afford internet or who live in areas without broadband.
ON THE RECORD
“By pursuing new policies that center racial and ethnic equity, expand access to high-quality, affordable care, and bolster the primary care workforce, we as a nation can ensure that the health care system fulfills its mission to serve all Americans,” wrote the Commonwealth Fund report authors.