Eliminating Health Disparities Measurement and Data Needs (2004) / Chapter Skim
Currently Skimming:
6 Private-Sector Collection of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation and Language Use
6 Private-Sector Collection of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation and Language Use
Pages 99-117
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 99... ...
Data collected by hospitals are aggregated at the state and federal level for these statistical purposes; data collected by physicians and by health plans are aggregated to a lesser extent.
|
From page 100... ...
It should be noted that these private record collection systems sometimes share data on a limited basis with states and with federal data systems; for example, the National Hospital Discharge Survey (NHDS) , which was discussed in Chapter 4, is a federally sponsored survey of records collected by hospitals on 1We do not include records of encounters at Veterans Health Administration or VA hospitals in this chapter, although data on veterans' use of health care services have been used to study racial and ethnic disparities in health care (for example, Jha et al., 2001)
|
From page 101... ...
Information is kept on the patient's treatment during the hospital stay and compiled in a document that is completed when the patient is discharged, called the discharge abstract.3 Many of these discharge abstracts are forwarded to state health agencies or to the federal government for statistical purposes. The National Hospital Discharge Survey collects medical records from a sample of nonfederal (which excludes military and VA hospitals)
|
From page 102... ...
and the Employee Retirement Income and Security Act (ERISA) , both of which establish some national standards for the regulation of health care in the private sector, are other important parts of the legal backdrop for collecting racial and ethnic data that may affect private-sector health data collection.
|
From page 103... ...
explicitly prohibit or partially prohibit the collection of racial, ethnic, SEP, and language data on insurance application forms in the individual or group insurance market (National Health Law Program, in press) .7 Five other states have regulations that could discourage the collection of data on race, ethnicity, and SEP: in Connecticut, Iowa, Minnesota, South Dakota, and Washington, when a health plan seeks state approval for its application forms, those that ask about race or ethnicity may be either disapproved or scrutinized closely.
|
From page 104... ...
Transaction sets help standardize the business interactions among health care providers, health plan payers, and health plan sponsors; code sets define the data element values used in the standard transactions. Every time health care providers electronically transmit a claim to an insurer and in turn to the Centers for Medicare and Medicaid Services (CMS)
|
From page 105... ...
Nerenz and Currier review racial and ethnic data collected by hospitals, health plans, and medical group practices. Bocchino discusses the results of interviews with health plans regarding their racial and ethnic data collection practices.
|
From page 106... ...
The HRET survey discovered that the majority (70 percent) of responding hospitals that collect racial and ethnic data did not see any drawbacks to collecting the data.
|
From page 107... ...
For example, Bocchino in Appendix G, interviewed 30 health insurers who were members of the American Association of Health Plans about their racial and ethnic data collection practices.11 This study found that of these 11See her paper in Appendix G Sixteen of these insurers were chosen for interview because they were known to have initiated race- and ethnicity-related projects.
|
From page 108... ...
Otherwise, no other SEP data were collected by the groups in this plan. Awareness of the potential utility of the collection of racial and ethnic data by health insurers was raised recently when Aetna, which insures 14 million individuals, announced that it would begin collecting racial and ethnic data from its members either once they were accepted for coverage or when they requested a change in coverage (Winslow, 2003)
|
From page 109... ...
In her survey of AAHP health insurers, Bocchino reports that data on race, ethnicity, language preference, and other individual characteristics such as sex, age, education, and geographic location are important for health insurers to appropriately target information and programs to improve the health of enrolled members. In Bocchino's study, health insurers that collect these data reported that when the data were provided by enrollees and recorded on their enrollment forms, they were in fact useful for identifying populations at higher risk for chronic conditions and for targeting appropriate preventive care programs.
|
From page 110... ...
While Nerenz and Currier found that some practices collect racial and ethnic data on their patients, the information is usually collected for their own purposes (e.g., internal quality improvement and disease management activities) and is therefore not standardized, consistently collected, or made available for public use.
|
From page 111... ...
Geographical linkages to CAHPS data are also possible. Although the main purpose of CAHPS is to support comparative reporting on health insurers, individual-level data are collected by some survey sponsors and are compiled on a voluntary basis in the National CAHPS Benchmarking Database to be used in research.
|
From page 112... ...
Racial and ethnic data could be used to develop culturally appropriate outreach for patient enrollment in these programs and ensure that follow-up support services are culturally appropriate. Moreover, data on race and ethnicity would enhance health insurer data sets and contribute to understanding disparities in preventive and palliative care among commercially insured populations.
|
From page 113... ...
The case for the proposed changes would be strengthened by the argument that the collection of racial and ethnic data is essential to meeting the Healthy People 2010 initiative to eliminate disparities in health and
|
From page 114... ...
, which is an independent nonprofit organization that is a standard-setting and accrediting body for more than 16,000 health care organizations. JCAHO already requires the collection of primary language information and could add requirements for the collection of racial and ethnic data.
|
From page 115... ...
This approach may help assuage fears about confidentiality breaches and may encourage individuals to provide the data. Promoting Standardized Collection of Data DHHS should work with hospitals and health insurers to determine the best way to collect standardized data, using the OMB standards for collecting racial and ethnic data as a base.
|
From page 116... ...
This information should be provided at the data collection point, which in most cases would be when the patients and plan enrollees fill out forms. Acknowledging the risks associated with the collection and use of data on race and ethnicity is part of the due diligence of the collection of these data by hospitals, health plans, and medical groups.
|
From page 117... ...
Alternatively, a private-sector vendor with the necessary geocoding expertise could be recruited, although such vendors do not typically deal with the related confidentiality issues. RECOMMENDATION 6-3: DHHS should establish a service that would geocode and link addresses of patients or health plan members to census data, with suitable protections of privacy, and make this service available to facilitate development of geographically linked ana lytic data sets.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.