Health Affairs
March/April 2005
Overcoming Disparities In U.S. Health Care
By William H. Frist
…the best way to eliminate health disparities is through improvements in the care we deliver to each patient, emphasizing patient dignity and empowerment.
Patients must be central to our efforts to improve health care. For instance, a person with a chronic illness such as diabetes must essentially “own” that illness if he or she is to have any hope of effectively managing it. Providers can help with high-quality treatment and the best recommendations, but patients must act on those recommendations. They must stop smoking, eat right, exercise, take their medication, and monitor their blood sugar, based on their own volition and usually outside of the clinical setting. Public policies must encourage patients to embrace personal responsibility.
Policies that promote dignity and personal responsibility will help decrease individuals’ risky behavior. The major causes of death among African Americans, for instance, are heart disease, cancer, stroke, accidents, and diabetes. Most of these are chronic diseases rather than acute illnesses, and all of these causes of death are at least arguably preventable.
Further, the top three can be reduced by decreasing tobacco use alone. We must
promote policies that help people address individual behavior, such as smoking.
Some have voiced concerns that health care is somehow different: that the
therapeutic relationship between doctor and patient should not be subject to
competitive forces. Further, many argue that quality chasms and health disparities cannot be fixed by fostering competition. Certainly, competition does not provide all of the answers. We will need a strong safety net and vigorous attention to vulnerable populations. But all of our immediate health care system problems-rising costs, questionable quality, patient safety, rising numbers of uninsured people, and, yes, health disparities-are interrelated and can be improved by empowering patients and providers.
We simply cannot afford to forgo the lower costs and increased quality and value that the right kind of competition will drive.
http://content.healthaffairs.org/cgi/content/abstract/24/2/445
Health Affairs
March/April 2005
The Role Of The Federal Government In Eliminating Health Disparities
By Edward M. Kennedy
The state of U.S. minority health is an embarrassment to the nation. Minority communities are struggling with rising numbers of uninsured citizens, festering epidemics, and lower health care quality, all of which mean increased rates of diseases and preventable deaths. To end the minority health crisis, Congress and the Bush administration need to step up to the plate by increasing health insurance coverage and investing in cultural competence, workforce diversity, minority data collection and reporting, and overall public health. Greater resources should be given to the HHS Office for Civil Rights and Office of Minority Health, both of which lead the fight to reduce disparities. All of these efforts must be integrated into the larger effort to increase access and improve quality of care, since we face not only a minority problem, but a national problem. In addition, the country must be mindful that health is inextricably tied to educational opportunities for children, job security and living wages for families,
safe and affordable community housing, and pension stability and social security
for seniors. Elimination of disparities in health depends in part on progress in each of these critical areas.
Health insurance for all is still my overarching goal, so that the basic right to health care can become a reality for all citizens.
http://content.healthaffairs.org/cgi/content/abstract/24/2/452
Comment: Perhaps the most appropriate comment comes from an article in this
same issue of Health Affairs: The Role Of Health Insurance Coverage In Reducing Racial/Ethnic Disparities In Health Care, by Marsha Lillie-Blanton and Catherine Hoffman:
“To assess whether insurance expansions could be expected to reduce racial/ethnic disparities in access to care, this paper reviews evidence from studies specifically designed to quantify the contribution of health insurance to racial/ethnic disparities in access. The studies provide evidence that a sizable share of the differences in whether a person has a regular source of care could be reduced if Hispanics and African Americans were insured at levels comparable to those of whites.”
http://content.healthaffairs.org/cgi/content/abstract/24/2/398