In the course of my time covering and writing about disparities in health care outcomes and efforts to improve equity of care for all Americans, I've often noticed that even as health care providers and advocates are giving the issue greater and greater attention, discouraging news from the field keeps pouring in, suggesting that national progress on reducing disparities is still slow.


This year in particular has seen more action than ever from the provider community on reducing disparities, as the moral imperative for doing so is increasingly joined by the realization that national and local efforts to improve quality and control costs have heightened the business case for improving outcomes for all Americans, and have made ignoring disparities reduction a financial impossibility. The American Hospital Association is among the groups leading the charge on this front, with the start of the National Call to Action to Eliminate Health Care Disparities. And a new Commonwealth Fund report released this month, Ensuring Equity: A Post Reform Framework to Achieve High-Performance Health Care for All Americans, calls equity of care "a core goal of a high-performance health system."

On the other side of the coin, negative news about disparities is distressingly easy to find. Recently, I wrote about a new CDC report that found while overall health outcomes for a variety of health conditions have been on the uptick since 2000, little progress has been made in reducing disparities. The report found progress in only 7 percent of the 28 health objectives it analyzed; disparities in care remained the same for 80 percent of the objectives and actually increased for the remaining 13 percent. And then there's the study recently published in Health Affairs that found that hospitals with the lowest quality scores and highest overall costs disproportionately serve elderly African-Americans, Hispanics and Medicaid patients, and are typically small, nonprofit institutions — in other words, the typical safety net providers.

The Commonwealth Fund report released this month notes the one-step-forward, one-step-back progress of the equity of care movement and the key role safety net hospitals play, noting that while the Affordable Care Act will increase access to care for millions of Americans, coverage in and of itself won't necessarily reduce disparities in health outcomes and comprehensive health services.

"Insurance alone is often not sufficient and does not guarantee access to high-quality care, particularly with regard to low-income families and racial and ethnic minorities," the report states.

Unsurprisingly, the report argues that safety net providers will be challenged by both the ACA and the current economic landscape to effectively serve those patients. While safety net providers will receive some new revenues from the ACA, the report speculates that reductions in Medicare payments alongside reduced revenue due to the tough economic climate could mean a loss in net revenue for many safety net hospitals, which in turn would "jeopardize access to care" for both the newly insured and individuals who remain uninsured.

So what should be done? The Commonwealth Fund report suggests a number of tactics, including incentives for providers to treat Medicaid patients, stabilizing insurance plans to ensure continuity of care and striking a balance between promoting high performance and increased clinical integration in safety net hospitals and stabilizing those institutions financially. The report also suggests greater coordination between health care providers and public health services to more efficiently tackle public health issues like obesity, diabetes and asthma.

To be sure, I know of many safety net hospitals that are currently tackling precisely those public health issues. It will be interesting to see what the next few years hold, though, as safety net providers fight the same economic challenges facing everyone else in addition to outsized pressure to improve outcomes and contribute to disparities reductions. Hopefully, the increased focus nationally on the issue, along with increased coverage for vulnerable populations, will begin to tip the scales toward true health care equity.

What do you think will be the tipping point for the equity of care movement? Send your thoughts to