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APPENDIX II PUBLIC TESTIMONY The committee devoted a day of its two-day March workshop to hearing testimony on the National Healthcare Disparities Report from 20 academics, advocates, and other national experts on racial, ethnic, geographic, and socioeconomic health care disparities. Table TT-1 presents the names and organizational affiliations of those who appeared. The committee invited these experts after soliciting suggestions from a number of sources, including AHRQ. Committee members Joseph Betancourt and Doriane Miller planned the public testimony sessions. Much of the testimony addressed two major issues: l. Nature of the report. Many of the experts called for AHRQ to produce a report that would help policy makers, advocates, health care professionals, and others to better understand the causes behind disparities. A descriptive report, they believed, would document the kinds of disparities that are already well known. However, they believed that a report that also examined the factors that produce disparities could provide the basis for legislation and other kinds of policy change aimed at eliminating disparities. It could also serve as a means to monitor progress made towards elimination. In addition, it could provide an agenda for professional education, quality improvement initiatives, and further disparities-oriented research. 2. Analysis of Disparities. Experts offered their views on how the NHDR should analyze health care disparities. Many called for the report to take into account health care as well as the physical, social, and economic factors that affect health status and care. These factors include educational quality, health and social services, community crime rates, housing quality, and insurance barriers. Some experts identified certain kinds of disparity issues that should be included in the report such as those involving priority and chronic conditions and the languages spoken by patients and providers. 185
186 GUIDANCE FOR THE NATIONAL HEALTH CARE DISPARITIES REPORT TABLE II-1 Expert Testimony on the National Healthcare Disparities Report EXPERT ORGANIZATION State University of New York Health Dennis Andrulis Ph.D. M.P.H. Sciences Center , , Association of Academic Health Roger J. Bulger, M.D., F.A.C.P. Centers Kathryn J. Coltin, M.P.H. American Association of Health Plans Sunset Park Family Health Center Merle Cunningham, M.D., M.P.H Network of Lutheran Medical Center Asian and Pacific Islander American Gem P. Daus, M.A. Health Forum Arthur B. Elster, M.D. American Medical Association Vanessa Northington Gamble, M.D., Health Policy and Medical Education Ph.D. Consultant Washington Business Group on Julianna Gonen, Ph.D. Health Gina Gregory-Burns, M.D. Kaiser Permanente American Association of People with Andrew J. Imparato, J.D. Disabilities Bette Keltner, Ph.D., R.N., F.A.A.N. American Nurses Association Nebraska Center for Rural Health Keith Mueller, Ph.D. Research, University of Nebraska Institute for Health Care Studies, David Nerenz, Ph.D. Michigan State University National Association for the Mentally Darlene Nipper, M.S. Ill Washington Business Group on ReaPanares M.H.S. Health , Lucille Norville Perez, M.D. National Medical Association American Association of Family Jeannette South-Paul, M.D. Physicians Association of State and Territorial Ulder Tillman, M.D., M.P.H. Health Officials National Association of City and Adewale Troutman, M.D., M.P.H. County Health Officials Steven Wilhide, M.P.H., M.S.W. National Rural Health Association
APPENDIX II 187 In addition, experts raised data-related issues such as the need to collect accurate data on insurance coverage, including provider and payment systems. This would avoid reliance on inaccurate recall by survey respondents. Data from health care plans on racial and ethnic identification could also be improved by, for example, coordinating the data that health care plans must gather, risk adjusting for disparity reporting, and formulating and disseminating interventions to eliminate disparities. Experts raised other analytical issues. They include the following: The report should present information on disparities that can inform health care policy at the federal, state, and local levels. The report should permit data on health care disparities to be tracked over time. The report should contain data that are especially pertinent to some races or ethnicities such as nativity and language r" . proIlclency. The report should recognize the diversity of geographic areas. For example, some rural areas are closer to major metropolitan areas than others and some suburban areas have substantial racial and ethnic populations. The report should use levels of analysis that include individuals, communities, and health care systems.