The last few months have seen a flurry of major announcements nationally that aim to finally reduce or eliminate racial and ethnic disparities in health care outcomes. At the same time, though, it seems hardly a day goes by without a new troubling headline identifying a new cause for concern.
On the positive side of the ledger, there's the Equity of Care project launched earlier this summer by the American Hospital Association and other partners and Aligning Forces for Quality, a $300 million initiative by the Robert Wood Johnson Foundation that's broadly designed to achieve equity in health care policy. On the other hand, last week saw the release of a study from the National Cancer Institute and Walter Reed Medical Center that found that while women of all races were equally likely to have mastectomies, African American women with tumors that spread beyond the breast were less likely to receive chemotherapy or hormonal therapy. I found that study particularly alarming, because the survey's participants were all members of the military or related beneficiaries, meaning that everyone involved in the study had similar insurance coverage. It also puts something of a damper on recent optimism that as the ACA increases access to care, some of the disparities-related issues around access to care will dissipate.
I've been wondering about precisely that issue ever since I saw leading disparities expert Joseph Betancourt, M.D., director of the Massachusetts-based Disparities Solution Center about a year ago during the 2010 Health Forum-AHA Leadership Summit. Betancourt was asked if the Massachusetts health reform initiative, which went into effect in 2006, had led to any reductions in disparities as more residents received access to primary care. At the time, Betancourt said that ED utilization—one measure of access to quality care, as patients with insurance coverage generally end up in the ED in lower numbers—had not changed significantly since the law went into effect in 2006, and noted that changing habits and behaviors can take time.
Overall, I believe most of the news of the last year on the disparities front has been positive, and that the sizeable investments in disparities issues will eventually have an impact. For the time being, though, it's clear that the way forward is going to be slow, and that all providers will need to be engaged to make real progress.