Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care (2003) / Chapter Skim
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5. Interventions: Systemic Strategies
5. Interventions: Systemic Strategies
Pages 180-198
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From page 180... ...
Given the role of patient, provider, and contextual factors in shaping the quality of patient care, systemic interventions directed at multiple levels offer promise to modify conditions in which healthcare disparities occur. Systemic interventions to improve healthcare delivery for diverse populations include organizational accommodations that may promote equity in healthcare, policies that reduce administrative and linguistic barriers to care, and practices that enhance patients' knowledge of and roles as active participants in the care process.
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From page 181... ...
Increasingly, health plan purchasers are also finding that health system responsiveness to the needs of racial and ethnic minority patients makes good business sense. Given that over 2 of every 5 new workers is a racial or ethnic minority, many employers find that health plan efforts to improve services for these populations and narrow the healthcare gap can attract better workers and increase employee productivity (Washington Business Group on Health, 2001~.
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From page 182... ...
"De-Fragmentation" of Healthcare Financing and Delivery Many of the studies cited earlier in this report have not taken detailed account of variations among health plans, and therefore the dispropor
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From page 183... ...
Further, as noted in Chapter 3, low per capita resources associated with lower-end plans may result in differences in the intensity of care between lower and higher end health plans. Studies consistently demonstrate an association between insur
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From page 184... ...
The relationship between racial and ethnic maldistribution in tiered health plans, differences in the intensity and the quality of care provided by these plans, and clinical outcomes should be a national research priority (see Chapter 8~. Until such research is conducted, it is reasonable to surmise that efforts to reduce the socioeconomic segmentation of the medical marketplace would help to diminish racial and ethnic disparities in healthcare provision (Bloche, 2001~.
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From page 185... ...
Several strategies can help to promote the stability of patient and provider relationships in publicly funded health plans. Federal and state performance standards for Medicaid-managed care plans, for example, should include guidelines for the stability of patients' assignments to primary care providers and these providers' accessibility.
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From page 186... ...
These bills were crafted on the assumption that due process protections of patient choices were necessary, despite a lack of empirical evidence that overall quality of care is inferior in managed care plans relative to fee-for-service systems. Extensive reviews of the literature do not establish whether the quality of care provided within managed care plans is worse (or better)
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From page 187... ...
Civil Rights Enforcement The committee believes that education and training of healthcare providers, administrators, and consumers is an important first step as part of a comprehensive, multi-level intervention strategy to address racial and ethnic disparities in healthcare. Enforcement of regulation and statute is also an important component of such a strategy, but unfortunately has been too often relegated to low-priority status.
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From page 188... ...
DHHS Office for Civil Rights to expand the agency's capabilities to address civil rights complaints and carry out its oversight responsibilities. HEALTH SYSTEMS INTERVENTIONS Research suggests that a variety of interventions applied at the level of health systems may be effective as a part of a comprehensive, multilevel strategy to address racial and ethnic disparities in healthcare.
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From page 189... ...
One means to address this balance disclosing health plans' clinical protocols would aid both private sector and public efforts in balancing the virtues of rules and discretion. Private accrediting entities and state regulatory bodies could require that health plans' clinical practice protocols be published with supporting evidence and thus open them to professional and consumer review.
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From page 190... ...
Where employers have an interest in providing an attractive benefit package, market forces protect middle and upper income groups against health plans "going too far" in rationing care. These protections are not available to all low-income groups, who must rely on balanced public policy to induce adequate supply of care.
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From page 191... ...
Language barriers may affect the delivery of adequate care through poor exchange of information, loss of important cultural information, misunderstanding of physician instruction, poor shared decision-making, and ethical compromises, such as difficulty obtaining informed consent (Woloshin et al., 1995~. In addition, low English reading proficiency may disproportionately and negatively affect many racial and ethnic minority patients' ability to read and understand written material from health plans and healthcare providers if appropriate translation is not provided.
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From page 192... ...
Four key elements for compliance with the guidelines include: an assessment of the needs of the population; comprehensive written policies on language access (including hiring of bilingual staff and interpreters, arranging for telephone interpreters) ; training of staff; and monitoring of programs to ensure people with limited English proficiency are adequately served.
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From page 193... ...
These individuals, often termed lay health advisors, neighborhood workers, indigenous health workers, health aids, consejera, or promotora, fulfill multiple functions in helping to improve health outcomes. They have been defined as being "community members who work almost exclusively in community settings and who serve as connectors between healthcare consumers and
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From page 194... ...
In addition to increasing access to services, some evidence suggests that lay health workers can help improve the quality of care and reduce costs (Witmer et al., 1995~. Lay workers can facilitate community participation in the health system, serve as liaisons between patients and providers, educate providers about community needs and the culture of the community, provide patient education, promote consumer advocacy and protection, contribute to continuity and coordination of care, assist in appointment attendance and adherence to medication regimens, and help to increase the use of preventive and primary care services (Brownstein et al., 1992; Earp and Flax, 1999; Jackson and Parks, 1997~.
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From page 195... ...
Finding 5-2: Community health workers offer promise as a community-based resource to increase racial and ethnic minorities' access to heathcare and to serve as a liaison between healthcare providers and the communities they serve. Recommendation 5-10: Support the use of community health workers.
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From page 196... ...
Recommendation 5-11: Implement multidisciplinary treatment and preventive care teams. Multidisciplinary teams offer promise as a means to improve and streamline care for racial and ethnic minority patients, and therefore should be more widely implemented.
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From page 197... ...
As patient education approaches become more widely used, efforts to evaluate their effectiveness have increased, and have demonstrated positive results. In one of the earliest papers examining the beneficial effects of patient education, Roter (1977)
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From page 198... ...
While most studies cited were not specifically targeted toward communities of color, positive results from patient education programs offer promise for their use with racial and ethnic minority patients. However, it is crucial that interventions be adapted with cultural and linguistic considerations in mind and also address physician responses to their patients' increased activation, to ensure collaborative interactions.
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