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From page 180... ... 5 Interventions: Systemic Strategies The preceding analysis of sources of racial and ethnic disparities in healthcare reveals that many participants -- including patients, their providers, utilization managers, and health system administrators -- make decisions on a daily basis that contribute to gaps in care. These individuals operate within many contexts, including clinical care settings and health system settings that set policies for access to and utilization of services, and at a larger level, are affected by laws and policies regulating the healthcare industry. Read the entire page →
From page 181... ... 181 INTERVENTIONS: SYSTEMIC STRATEGIES healthcare. First, they may react to comply with growing state and federal guidelines that encourage, and in some cases, mandate greater responsiveness on the part of health systems to the growing diversity of the U.S. Read the entire page →
From page 182... ... 182 UNEQUAL TREATMENT BOX 5-1 U.S. Department of Health and Human Services Standards for Culturally and Linguistically Appropriate Services 1. Read the entire page →
From page 183... ... 183 INTERVENTIONS: SYSTEMIC STRATEGIES 8. Healthcare Organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to pro vide culturally and linguistically appropriate services. Read the entire page →
From page 184... ... 184 UNEQUAL TREATMENT ance status and use of healthcare resources. For example, patients seen in emergency departments following head injury are more likely to be admitted to the hospital and have a longer length of stay if they are privately insured, rather than publicly insured or uninsured (Svenson and Spurlock, 2001) Read the entire page →
From page 185... ... 185 INTERVENTIONS: SYSTEMIC STRATEGIES isfaction and access to care. Having a usual source of care is associated, for example, with use of preventive care services. Read the entire page →
From page 186... ... 186 UNEQUAL TREATMENT Strengthening patient and provider relationships will also benefit from greater racial and ethnic diversity in the health professions. Racial concordance of patient and provider is associated with greater patient participation in care processes, higher patient satisfaction, and greater adherence to treatment (Cooper-Patrick et al., 1999) Read the entire page →
From page 187... ... 187 INTERVENTIONS: SYSTEMIC STRATEGIES As discussed in Chapter 3, however, there are reasons and empirical evidence to be concerned about how financial incentives and decisionmaking within managed health plans may differentially affect racial and ethnic minority groups. Some evidence indicates that low-income and ethnic minority patients enrolled in managed care plans are less likely to have a regular provider than similar patients in fee-for-service plans (Leigh, Lillie-Blanton, Martinez, and Collins, 1999) Read the entire page →
From page 188... ... 188 UNEQUAL TREATMENT Title VI of the 1964 Civil Rights Act) Read the entire page →
From page 189... ... 189 INTERVENTIONS: SYSTEMIC STRATEGIES Evidence-Based Cost Control As discussed in Chapter 3, medical science has made tremendous advances that have transformed clinical practice. Many innovations are available to healthcare providers, and the use of evidence-based practice guidelines to improve and standardize care has increased. Read the entire page →
From page 190... ... 190 UNEQUAL TREATMENT tiny, and used to examine the quality of care for racial and ethnic minorities. Financial Incentives in Healthcare As discussed in Chapter 3, financial factors, such as capitation and plan incentives to providers to practice frugally, can pose greater barriers to racial and ethnic minority patients than for whites, even among patients insured at the same level. Read the entire page →
From page 191... ... 191 INTERVENTIONS: SYSTEMIC STRATEGIES Payment systems to providers should ensure an adequate supply of services to racial and ethnic minority patients. Financial incentives to restrict care and pass liability to providers should be limited, to reduce conditions in which racial and ethnic stereotypes and biases may be exacerbated or reinforced. Read the entire page →
From page 192... ... 192 UNEQUAL TREATMENT effects of language concordance on health outcomes, such that having a physician who spoke Spanish resulted in higher ratings of physical and psychological well being, higher health perceptions, and lower perceptions of pain (Perez-Stable, Napoles-Springer, and Miramontes, 1997) Read the entire page →
From page 193... ... 193 INTERVENTIONS: SYSTEMIC STRATEGIES An important issue for future consideration is the establishment of minimum standards for training of translators and interpreters. Significantly, the U.S. Read the entire page →
From page 194... ... 194 UNEQUAL TREATMENT providers to promote health among groups that have traditionally lacked access to adequate care" (Witmer et al., 1995) Read the entire page →
From page 195... ... 195 INTERVENTIONS: SYSTEMIC STRATEGIES spoken, over conducting the education program without lay health workers (Corkery et al., 1997) Read the entire page →
From page 196... ... 196 UNEQUAL TREATMENT havioral and social risks that patients face, particularly racial and ethnic minority patients. They may save costs and improve the efficiency of care by reducing the need for face-to-face physician visits and improve patients' day-to-day care between visits. Read the entire page →
From page 197... ... 197 INTERVENTIONS: SYSTEMIC STRATEGIES were also developed for use by providers of healthcare to support and encourage use of the program. In addition, some medical institutions, such as the Ohio State University Medical Center and Cincinnati Children's Hospital Center, have established Internet-based programs to help answer patient questions about topics such as pain management, medications, medical procedures, nutrition, and health promotion. Read the entire page →
From page 198... ... 198 UNEQUAL TREATMENT egies (e.g., skill building, practice activities, modeling and contracting, rewards, mail and telephone reminders) and those that combined education and behavior strategies. Read the entire page →

From page 180...

... 5 Interventions: Systemic Strategies The preceding analysis of sources of racial and ethnic disparities in healthcare reveals that many participants -- including patients, their providers, utilization managers, and health system administrators -- make decisions on a daily basis that contribute to gaps in care. These individuals operate within many contexts, including clinical care settings and health system settings that set policies for access to and utilization of services, and at a larger level, are affected by laws and policies regulating the healthcare industry.