Skip to main content

Principles for Eliminating Racial and Ethnic Disparities in Healthcare

  • Chapter
Eliminating Healthcare Disparities in America

Abstract

The elimination of racial and ethnic disparities in health has become a national priority in the United States (1). These disparities have many causes and potential solutions. In the landmark Unequal Treatment report, the Institute of Medicine reviewed and highlighted racial and ethnic disparities in healthcare as an important factor contributing to disparities in health outcomes (2). This report concluded with a strong call for action to eliminate racial and ethnic disparities in the US healthcare system. Since 2003, the federal government has issued an annual National Healthcare Disparities Report to monitor racial, ethnic, and socioeconomic disparities in access to care and quality of care. Whereas the initial report released by the federal Department of Health and Human Services generated considerable controversy and debate about the content and interpretation of key findings (3), subsequent reports have become a useful tool for tracking national trends in disparities across a wide array of quality measures. In 2004, this report found that lower quality of care was experienced by African Americans for two-thirds of measures, by Hispanics for one-half of measures, and by American Indians/Alaskan Natives for one-third of measures (4).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. US Department of Health and Human Services. Health People 2010: Understanding and Improving Health, 2nd ed., US Government Printing Office, 2000. Washington, DC.

    Google Scholar 

  2. Institute of Medicine. (2002) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academy Press, Washington, DC.

    Google Scholar 

  3. Bloche, M. G. (2004) Health care disparities—science, politics, and race. N. Engl. J. Med. 350, 1568–1570.

    Article  PubMed  CAS  Google Scholar 

  4. Moy, E., Dayton, E., and Clancy, C. M. (2005) Compiling the evidence: the National Healthcare Disparities Reports. Health Aff. (Millwood) 24, 376–387.

    Article  Google Scholar 

  5. Groman, R. and Ginsburg, J. (2004) Racial and ethnic disparities in health care: a position paper of the American College of Physicians. Ann. Intern. Med. 141, 226–232.

    PubMed  Google Scholar 

  6. Carrasquillo, O., Lantigua, R. A., and Shea, S. (2001) Preventive services among Medicare beneficiaries with supplemental coverage versus HMO enrollees, medicaid recipients, and elders with no additional coverage. Med. Care 39, 616–626.

    Article  PubMed  CAS  Google Scholar 

  7. Institute of Medicine, Committee on the Consequences of Uninsurance. (2001) Coverage Matters: Insurance and Health Care. National Academy Press, Washington, DC.

    Google Scholar 

  8. Institute of Medicine, Committee on the Consequences of Uninsurance. (2002) Care without Coverage. Too Little, Too Late. National Academy Press, Washington, DC.

    Google Scholar 

  9. Institute of Medicine, Committee on the Consequences of Uninsurance. (2002) Health Insurance is a Family Matter. National Academy Press, Washington, DC.

    Google Scholar 

  10. Institute of Medicine, Committee on the Consequences of Uninsurance. (2003) A Shared Destiny. Community Effects of Uninsurance. National Academy Press, Washington, DC.

    Google Scholar 

  11. Franks, P., Clancy, C. M., and Gold, M. R. (1993) Health insurance and mortality. Evidence from a national cohort. JAMA 270, 737–741.

    Article  PubMed  CAS  Google Scholar 

  12. Sorlie, P. D., Johnson, N. J., Backlund, E., and Bradham, D. D. (1994) Mortality in the uninsured compared with that in persons with public and private health insurance. Arch. Intern. Med. 154, 2409–2416.

    Article  PubMed  CAS  Google Scholar 

  13. McWilliams, J. M., Zaslavsky, A. M., Meara, E., and Ayanian, J. Z. (2004) Health insurance coverage and mortality among the near-elderly. Health Aff. (Millwood) 23(4), 223–233.

    Article  Google Scholar 

  14. Ayanian, J. Z., Udvarhelyi, I. S., Gatsonis, C. A., Pashos, C. L., and Epstein, A. M. (1993) Racial differences in the use of revascularization procedures after coronary angiography. JAMA 269, 2642–2646.

    Article  PubMed  CAS  Google Scholar 

  15. Goldman, D. P., Bhattcharya, J., McCaffrey, D. F., et al. (2001) Effect of Insurance on mortality in an HIV-positive population in care. J. Am. Stat. Assoc. 96, 883–894.

    Article  Google Scholar 

  16. Bach, P. B., Pham, H. H., Schrag, D., Tate, R. C., and Hargraves, J. L. (2004) Primary care physicians who treat blacks and whites. N. Engl. J. Med. 351, 575–584.

    Article  PubMed  CAS  Google Scholar 

  17. Nerenz, D. R. (2005) Health care organizations’ use of race/ethnicity data to address quality disparities. Health Aff. (Millwood) 24, 409–416.

    Article  Google Scholar 

  18. (2005) AAMC Staff for Minorities in Medical Education. Minorities in Medical Education: Facts & Figures 2005. Association of American Medical Colleges, Washington, DC.

    Google Scholar 

  19. Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., et al. (1999) Race, gender, and partnership in the patient-physician relationship. JAMA 282, 583–589.

    Article  PubMed  CAS  Google Scholar 

  20. Cooper, L. A., Roter, D. L., Johnson, R. L., Ford, D. E., Steinwachs, D. M., and Powe, N. R. (2003) Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann. Intern. Med. 139, 907–915.

    PubMed  Google Scholar 

  21. Chen, F. M., Fryer, G. E., Jr., Phillips, R. L., Jr., Wilson, E., and Pathman, D. E. (2005) Patients’ beliefs about racism, preferences for physician race, and satisfaction with care. Ann. Fam. Med. 3, 138–143.

    Article  PubMed  Google Scholar 

  22. Chen, J., Rathore, S. S., Radford, M. J., Wang, Y., and Krumholz, H. M. (2001) Racial differences in the use of cardiac catheterization after acute myocardial infarction. N. Engl. J. Med. 344, 1443–1449.

    Article  PubMed  CAS  Google Scholar 

  23. Epstein, A. M. and Ayanian, J. Z. (2001) Racial disparities in medical care. N. Engl. J. Med. 344, 1471–1473.

    Article  PubMed  CAS  Google Scholar 

  24. Institute of Medicine. (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, Washington, DC.

    Google Scholar 

  25. Cleary, P. D., Edgman-Levitan, S., Roberts, M., et al. (1991) Patients evaluate their hospital care: a national survey. Health Aff. (Millwood) 10(4), 254–267.

    Article  CAS  Google Scholar 

  26. Ayanian, J. Z., Zaslavsky, A. M., Guadagnoli, E., et al. (2005) Patients’ perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J. Clin. Oncol. 23, 6576–6586.

    Article  PubMed  Google Scholar 

  27. Schrag, D. (2005) Communication and coordination: the keys to quality. J. Clin. Oncol. 23, 6452–6455.

    Article  PubMed  Google Scholar 

  28. Office of Minority Health. (2001) National Standards for Cultural and Linguistically Appropriate Services in Health Care. Final Report. US Department of Health and Human Services, Washington, DC.

    Google Scholar 

  29. Beach, M. C., Price, E. G., Gary, T. L., et al. (2005) Cultural competence: a systematic review of health care provider educational interventions. Med. Care 43, 356–373.

    Article  PubMed  Google Scholar 

  30. Betancourt, J. R., Green, A. R., Carrillo, J. E., and Ananeh-Firempong, O., 2nd. (2003) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 118, 293–302.

    PubMed  Google Scholar 

  31. Betancourt, J. R., Green, A. R., Carrillo, J. E., and Park, E. R. (2005) Cultural competence and health care disparities: key perspectives and trends. Health Aff. (Millwood) 24(2), 499–505.

    Article  Google Scholar 

  32. Fiscella, K., Franks, P., Gold, M. R., and Clancy, C. M. (2000) Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA 283, 2579–2584.

    Article  PubMed  CAS  Google Scholar 

  33. Bierman, A. S., Lurie, N., Collins, K. S., and Eisenberg, J. M. (2002) Addressing racial and ethnic barriers to effective health care: the need for better data. Health Aff. (Millwood) 21(3), 91–102.

    Article  Google Scholar 

  34. Schneider, E. C., Riehl, V., Courte-Wienecke, S., Eddy, D. M., and Sennett, C. (1999) Enhancing performance measurement: NCQA’s road map for a health information framework. National Committee for Quality Assurance. JAMA 282, 1184–1190.

    Article  PubMed  CAS  Google Scholar 

  35. Schneider, E. C., Zaslavsky, A. M., Landon, B. E., Lied, T. R., Sheingold, S., and Cleary, P. D. (2001) National quality monitoring of Medicare health plans: the relationship between enrollees’ reports and the quality of clinical care. Med. Care 39, 1313–1325.

    Article  PubMed  CAS  Google Scholar 

  36. Jha, A. K., Li, Z., Orav, E. J., and Epstein, A. M. (2005) Care in US hospitals—the Hospital Quality Alliance program. N. Engl. J. Med. 353, 265–274.

    Article  PubMed  CAS  Google Scholar 

  37. Hasnain-Wynia, R. and Baker, D. W. (2006) Obtaining data on patient race, ethnicity, and primary language in health care organizations: current challenges and proposed solutions. Health Serv. Res. 41, 1501–1518.

    PubMed  Google Scholar 

  38. Sequist, T. D. and Schneider, E. C. (2006) Addressing racial and ethnic disparities in health care: using federal data to support local programs to eliminate disparities. Health Serv. Res. 41, 1451–1468.

    PubMed  Google Scholar 

  39. Arday, S. L., Arday, D. R., Monroe, S., and Zhang, J. (2000) HCFA’s racial and ethnic data: current accuracy and recent improvements. Health Care Financ. Rev. 21, 107–116.

    PubMed  CAS  Google Scholar 

  40. Baker, D. W., Cameron, K. A., Feinglass, J., et al. (2005) Patients’ attitudes toward health care providers collecting information about their race and ethnicity. J. Gen. Intern. Med. 20, 895–900.

    Article  PubMed  Google Scholar 

  41. Fremont, A. M., Bierman, A., Wickstrom, S. L., et al. (2005) Use of geocoding in managed care settings to identify quality disparities. Health Aff. (Millwood) 24, 516–526.

    Article  Google Scholar 

  42. Fiscella, K. and Fremont, A. M. (2006) Use of geocoding and surname analysis to estimate race and ethnicity. Health Serv. Res. 41, 1482–1500.

    PubMed  Google Scholar 

  43. Wei, I. I., Virnig, B. A., John, D. A., and Morgan, R. O. (2006) Using a Spanish surname match to improve identification of Hispanic women in Medicare administrative data. Health Serv. Res. 41, 1469–1481.

    PubMed  Google Scholar 

  44. Aaron, K. F. and Clancy, C. M. (2003) Improving quality and reducing disparities: toward a common pathway. JAMA 289, 1033–1034.

    Article  PubMed  Google Scholar 

  45. Sehgal, A. R. (2003) Impact of quality improvement efforts on race and sex disparities in hemodialysis. JAMA 289, 996–1000.

    Article  PubMed  Google Scholar 

  46. Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., and Ayanian, J. Z. (2005) Trends in the quality of care and racial disparities in Medicare managed care. N. Engl. J. Med. 353, 692–700.

    Article  PubMed  CAS  Google Scholar 

  47. Sequist, T. D., Adams, A., Zhang, F., Ross-Degnan, D., and Ayanian, J. Z. (2006) Effect of quality improvement on racial disparities in diabetes care. Arch. Intern. Med. 166, 675–681.

    Article  PubMed  Google Scholar 

  48. Rathore, S. S., Foody, J. M., Wang, Y., et al. (2003) Race, quality of care, and outcomes of elderly patients hospitalized with heart failure. JAMA 289, 2517–2524.

    Article  PubMed  Google Scholar 

  49. Jessup, J. M., Stewart, A., Greene, F. L., and Minsky, B. D. (2005) Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. JAMA 294, 2703–2711.

    Article  PubMed  CAS  Google Scholar 

  50. Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., and Ayanian, J. Z. (2006) Relationship between quality of care and racial disparities within Medicare health plans. JAMA 296, 1998–2004.

    Article  PubMed  CAS  Google Scholar 

  51. Satcher, D., Fryer, G. E., Jr., McCann, J., Troutman, A., Woolf, S. H., and Rust, G. (2005) What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000. Health Aff. (Millwood) 24, 459–464.

    Article  Google Scholar 

  52. Murray, C. J., Kulkarni, S. C., Michaud, C., et al. (2006) Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 3, PLoS Med. 3, e357.

    Google Scholar 

  53. Wong, M. D., Shapiro, M. F., Boscardin, W. J., and Ettner, S. L. (2002) Contribution of major diseases to disparities in mortality. N. Engl. J. Med. 347, 1585–1592.

    Article  PubMed  Google Scholar 

  54. Zaslavsky, A. M. and Ayanian, J. Z. (2005) Integrating research on racial and ethnic disparities in health care over place and time. Med. Care 43, 303–307.

    Article  PubMed  Google Scholar 

  55. Bradley, E. H., Herrin, J., Wang, Y., et al. (2004) Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction. JAMA 292, 1563–1572.

    Article  PubMed  CAS  Google Scholar 

  56. Skinner, J., Chandra, A., Staiger, D., Lee, J., and McClellan, M. (2005) Mortality after acute myocardial infarction in hospitals that disproportionately treat black patients. Circulation 112, 2634–2641.

    Article  PubMed  Google Scholar 

  57. Barnato, A. E., Lucas, F. L., Staiger, D., Wennberg, D. E., and Chandra, A. (2005) Hospital-level racial disparities in acute myocardial infarction treatment and outcomes. Med. Care 43, 308–319.

    Article  PubMed  Google Scholar 

  58. Lucas, F. L., Stukel, T. A., Morris, A. M., Siewers, A. E., and Birkmeyer, J. D. (2006) Race and surgical mortality in the United States. Ann. Surg. 243, 281–286.

    Article  PubMed  CAS  Google Scholar 

  59. US Census Bureau, Current Population Survey, March, 2005.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Humana Press Inc.

About this chapter

Cite this chapter

Ayanian, J.Z., Williams, R.A. (2007). Principles for Eliminating Racial and Ethnic Disparities in Healthcare. In: Williams, R.A. (eds) Eliminating Healthcare Disparities in America. Humana Press. https://doi.org/10.1007/978-1-59745-485-8_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-485-8_18

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-934115-42-8

  • Online ISBN: 978-1-59745-485-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics