Health­care just one sec­tor strug­gling to close gap be­tween haves and have-nots

Modern Healthcare - - Front Page - DAVID MAY As­sis­tant Man­ag­ing Edi­tor/fea­tures

Health­care only one sec­tor strug­gling to ad­dress dis­par­i­ties

Look up the word “dis­par­ity” in the dic­tio­nary and the first def­i­ni­tion you’re likely to find is “in­equal­ity.” And in Amer­ica, sup­pos­edly the land of equal op­por­tu­nity, that’s a term that makes most of us squirm. Our coun­try con­tin­ues to strug­gle with far too many dis­par­i­ties. There’s the per­va­sive in­come gap, whether by gen­der or mi­nor­ity group. We also have a grow­ing wealth gap, a vast chasm be­tween the haves and have-nots. Mean­while, our stu­dents have been con­fronting ed­u­ca­tional dis­par­i­ties for decades.

And then we have the U.S. health­care sys­tem. Over­all qual­ity, ac­cess to care and the out­comes of that care have long been wildly in­con­sis­tent whether lo­cally or re­gion­ally, but es­pe­cially so­cio-eco­nom­i­cally.

Of course we know it’s a Utopian ideal to ex­pect equal­ity for ev­ery­one in all things. In ed­u­ca­tion, for ex­am­ple, yes, all chil­dren have dif­fer­ent gifts and abil­i­ties, but it doesn’t mean we can’t try to level the play­ing field when it comes to fi­nan­cial re­sources, ac­cess to the lat­est text­books and hir­ing ex­pe­ri­enced teach­ers.

The same con­cept ap­plies to health­care. While we all have dif­fer­ent pre­dis­po­si­tions to disease, ev­ery­one should have ac­cess to preven­tive care and ad­e­quate health in­surance. And no, it is not cor­rect to say that all Amer­i­cans have equal ac­cess to care just be­cause we can al­ways head to the near­est emer­gency room and be treated.

But it’s not as if the health­care in­dus­try hasn’t been try­ing to mit­i­gate the dis­par­i­ties. Our shelves are stacked high with stud­ies, and health­care or­ga­ni­za­tions have been ac­tively work­ing the prob­lem. Mod­ern Health­care re­porter Paul Barr wrote just last week about a new ini­tia­tive (July 25, p. 10).

As he re­ported, five prom­i­nent or­ga­ni­za­tions—the Amer­i­can Col­lege of Health­care Ex­ec­u­tives, Amer­i­can Hos­pi­tal As­so­ci­a­tion, As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges, Catholic Health As­so­ci­a­tion and the Na­tional As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems—are pool­ing their re­sources in a fit­tingly ti­tled Equity of Care cam­paign.

The key mes­sage is that the dis­par­ity is­sue is re­ally a qual­ity is­sue, with about one-third of our nation’s pop­u­la­tion—racial and eth­nic mi­nori­ties—at risk of suf­fer­ing from dis­par­i­ties in qual­ity of care. And that per­cent­age is grow­ing. The cam­paign aims to make progress through data col­lec­tion and anal­y­sis, an em­pha­sis on “cul­tural com­pe­tency,” and broad­en­ing the di­ver­sity of health­care gov­ern­ing boards.

We laud these or­ga­ni­za­tions for their ef­forts and urge oth­ers to join them.

Mean­while, one area where we’re clearly on the wrong track when it comes to elim­i­nat­ing dis­par­i­ties in­volves the eco­nomic health of our pop­u­la­tion. In a widely cited study is­sued last week, the Pew Re­search Cen­ter re­ported that the “wealth gap” be­tween whites and mi­nori­ties is the widest in 25 years.

Ac­cord­ing to Pew, the me­dian net worth of whites is now 20 times that of black house­holds and 18 times that of His­panic fam­i­lies. Blame it on the Great Re­ces­sion. From 2005 to 2009, white house­holds saw me­dian net worth fall 16%, but for His­pan­ics the drop was a stun­ning 66% and for blacks, 53%.

Most of the drop for the mi­nor­ity groups tracks the de­cline of home val­ues—the main in­vest­ment of many fam­i­lies. For whites, ac­cord­ing to Pew, a larger per­cent­age of net worth was in other in­vest­ments such as eq­ui­ties, which re­cov­ered sig­nif­i­cantly from their re­ces­sion­ary lows. Not so for home prices.

These re­sults are rel­e­vant in the health­care arena be­cause they show just how frag­ile the per­sonal safety nets of these fam­i­lies have be­come. When they face un­em­ploy­ment and loss of health in­surance, they have few re­sources left should a med­i­cal emer­gency arise.

The find­ings point to more un­com­pen­sated care and bad debt for providers. Worst of all they mean more eco­nomic mis­ery for our neigh­bors.

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