The National Academies Press

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Pages 1-16

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From page 1... ... Despite being the country that spends the most money on health care among all high-income countries, the United States has some of the worst population health outcomes and is far from achieving optimal health for all. Its health care system is broken and by its very design, delivers different outcomes for different populations, resulting in persistent and profound health care inequities. Read the entire page →
From page 2... ... Because much work remains to be done to eliminate health care inequities and advance optimal health for all in the United States, the Agency for Healthcare Research and Quality and the National Institutes of Health requested that the National Academies of Sciences, Engineering, and Medicine conduct a study to review the major drivers of health care inequities, provide insight into successful and unsuccessful interventions, identify gaps in the evidence base, propose strategies to close those gaps, consider ways to scale and spread effective interventions to reduce racial and ethnic inequities in health care, and make recommendations to advance health equity. THE COMMITTEE'S GUIDING FRAMEWORK The statement of task to the committee specifies that "the committee will consider ways to scale and spread effective interventions to reduce racial and ethnic disparities in health care and make recommendations to Read the entire page →
From page 3... ... to serve as a unifying basis for its approach to the report organization and recommendations for action. Because the health care system exists within the larger society, the conceptual framework highlights five key societal external forces, each representing a significant influence on equitable health care: structural Key External Societal Equitable Health Care System Forces Structural Determinants of Health Health Care Health Care Laws and Payment Service Delivery Policies Oppression and Structural Racism Community Centeredness Outcome Social Determinants of Health and Engagement Optimal Health for All Non-Health Care Sector Partnerships Discovery and Accountability Evidence Generation Societal Commitment to Equity FIGURE S-1 Committee's Conceptual Framework. Read the entire page →
From page 4... ... • The interest of partners outside the health care sector, such as social service agencies, can shape priorities and programs of health care systems, either negatively, by exacerbating inequities and widening inequity gaps, or positively, by unlocking long-term opportunities to advance health care equity. • Societal commitment to identify and remove barriers and create equitable access to resources to achieve equal opportunities posi tively impacts health and health care; the lack thereof reinforces health and health care inequities. Read the entire page →
From page 5... ... • Discovery and Evidence Generation. Data and research are critical resources needed to implement, evaluate, and enforce strategies to eliminate racial and ethnic health care inequities and advance health equity. Read the entire page →
From page 6... ... 2. Racial and ethnic health care inequities are driven by a complex interaction between health care and key external societal forces that serve as enablers or barriers to achieving equitable health care and optimal health. Read the entire page →
From page 7... ... Inadequate enforcement of current laws and policies that promote equitable health care to advance health equity has hin dered progress. Enhancing systems of accountability throughout the health care system, with a focus on achieving equity and opti mal health, are required. Read the entire page →
From page 8... ... Based on the overarching conclusions, the committee provides a range of recommended implementation actions. The goals of these recommendations are to: • Generate accurate and timely data on inequities; • Equip health care systems and expand effective and sustainable interventions; • Invest in research and evidence generation to better identify and widely implement interventions that eliminate health care inequities; • Ensure adequate resources to enforce existing laws and build sys tems of accountability that explicitly focus on eliminating health care inequities and advancing health equity and; • Eliminate inequities in health care coverage, access, and quality. Read the entire page →
From page 9... ... The variation in performance measures for health care equity impedes efforts to hold health care systems, organizations, and clinicians accountable for their performance in promoting equitable health care outcomes. Health equity should become an expectation of the entire health care delivery system and expectations of high-quality care should include equity as a core value at the organizational level. Read the entire page →
From page 10... ... 2-3. The Centers for Medicare & Medicaid Services should expand the number of Section 1115 demonstrations designed to address adverse social determinants of health by combining clinical care with investments in health-related social needs as an element of care delivery. Health equity should be incorporated explicitly as a goal of program design, payment structure, and evaluation. Read the entire page →
From page 11... ... New approaches, including community-based research and studies in primary care settings, show promise to advance interventions to improve health and health care equity, but few implementation studies or comparative effectiveness studies have occurred to facilitate adoption of the most effective interventions. To achieve this goal, the committee recommends the following actions: Implementation Actions: 3-1. National Institutes of Health and other federal and non-federal research funders should expand funding for research aimed at addressing health care inequities, structural racism, and health related social needs, and exploring the various approaches, strategies, and policies needed to eliminate health care inequi ties. Read the entire page →
From page 12... ... Goal 4: Ensure Adequate Resources to Enforce Existing Laws and Build Systems of Accountability that Explicitly Focus on Eliminating Health Care Inequities and Advancing Health Equity Many current laws and regulations have been underused. The Office for Civil Rights (OCR) Read the entire page →
From page 13... ... . These structural inequities result in unequal access to health care services. Read the entire page →
From page 14... ... The ACA expanded health care coverage to millions of low-income individuals and set in motion long-term changes in how health care is organized and delivered, spurring greater emphasis on integrating it with services aimed at addressing HRSNs. However, structural limitations, lack of enforcement, and Supreme Court rulings on ACA provisions have stalled broad implementation and even sometimes reversed the trajectories intended. Read the entire page →
From page 15... ... With concerted national efforts and adequate resources, the health care system can be transformed to deliver high-quality, equitable care to all and contribute to the larger societal goal of achieving optimal health for all. We are all in this together. Read the entire page →

From page 1...

... Despite being the country that spends the most money on health care among all high-income countries, the United States has some of the worst population health outcomes and is far from achieving optimal health for all. Its health care system is broken and by its very design, delivers different outcomes for different populations, resulting in persistent and profound health care inequities.

Summary Pages 1-16

Summary
Pages 1-16