Reduction in disparities requires both insurance and a medical home
Health Care Disconnect: Gaps in Coverage and Care for Minority Adults
By Michelle M. Doty and Alyssa L. Holmgren
The Commonwealth Fund
August 2006
Lack of insurance coverage and instability of coverage are persistent problems for low-income adults and racial and ethnic minorities. The Commonwealth Fund Biennial Health Insurance Survey (2005) documented that Hispanic working-age adults are particularly likely to lack basic access to medical care. This can be attributed in part to their very high uninsured rates, but it is also because of the difficulties Hispanics experience in establishing ongoing care relationships with their doctors. Findings suggest that improving coverage as well as access to a medical home would go a long way toward helping Hispanic adults connect with the health care system, receive the preventive care they need, and successfully manage and control chronic conditions.
Rates of unpaid medical bills and debt, meanwhile, are particularly high among African Americans, a consequence of the high prevalence of chronic disease and high uninsured rates found in this population. Helping to prevent the financial strain associated with unpaid medical bills and accrued debt should be a top priority area for policymakers.
Insurance alone does not ensure equal access and equal care. Having a regular doctor is important as well, in terms of timing and receipt of preventive care. Indeed, findings indicate that on certain measures of preventive care, there are few racial and ethnic disparities among Hispanics, African Americans, and whites once they have a regular doctor.
Whether insured or uninsured, or below or above poverty, people who have a regular provider are significantly more likely to get recommended preventive care, such as blood pressure and cholesterol screenings, and to feel confident about self-managing their chronic conditions. Ensuring that people have a medical home may thus be an important lever for reducing racial and ethnic disparities in care.
http://www.cmwf.org/usr_doc/941_Doty_hlt_care_disconnect_disparities_issue_bri.pdf
Comment:
By Don McCanne, M.D.
No reasonable person disputes that lack of insurance has been a major contributor to racial and ethnic disparities in care. Establishing a program of universal, comprehensive health care coverage may not be the only measure required, but it is absolutely essential. Health care access will always be impaired if there is not in place a system of paying for that care.
This study also demonstrates that lack of a medical home (primary care) also results in racial and ethnic disparities. We are currently witnessing an acceleration in the deterioration of our primary care infrastructure. Our current flawed method of funding health care has shifted financial resources from primary care to more lucrative, higher-tech services. Being able to pay for primary care is not enough if there is no primary care home to turn to.
A single payer national health insurance program not only would ensure that care would be paid for, but it also has the capability of correcting many of the structural defects in our health care system. One of the most important is that it could realign incentives to improve and expand our primary care infrastructure, ensuring that everyone would have access to a medical home.
Single payer is not only an insurance model. It is also a beneficent monopsony: a single purchaser of health care for the public good. As such, it would not only fund health care, but it would also enable much needed structural reforms such as improving the primary care infrastructure, improving pricing, reducing non-beneficial high-tech excesses, and dramatically reducing the profound administrative waste of our current, fragmented system.