Strategies to Reduce Health Disparities

Workshop Brief for State, Local, and Tribal Policymakers

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This workshop was designed for senior State, local, and tribal policymakers who are responsible for planning, implementing, and evaluating health care programs and policy options. The workshop was held in Tucson, Arizona, April 4-6, 2001.

About the Workshop Sponsor.

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Overview

Objectives

At the completion of this workshop, participants were expected to be better able to:

• Understand the roots of observed health disparities and identify the points at which they can take action to reduce these disparities.
• Describe barriers to access that affect significant numbers of racial and ethnic minorities, including lack of health insurance and physical barriers, and identify strategies to reduce these barriers.
• Identify reasons for the lack of minority representation among clinical providers and describe promising strategies to increase these numbers.
• Describe methods of using purchasing power to improve contractors' ability to deliver care in a multicultural society.
• Understand the ways in which data can be used to identify and target efforts to reduce disparities.

Session Summaries

Demographic Trends

A number of demographic factors significantly increase policymakers' and program developers' need to address racial and ethnic health disparities. For example, minority population growth is outpacing the white population growth. As overall birth rates in the United States decrease, immigrants will become an increasingly important proportion of the working-age population.

"Voltage Drops" in Care

Many factors can interfere with the health care systems' ability to meet peoples' needs. At any number of junctures, the quality of care can diminish. "Voltage drops" in the quality of the Nation's health care system can occur with: access to insurance coverage; enrollment in available insurance plans; access to covered services, clinicians, and health care institutions; choice of plans, clinicians, and health care institutions; access to a consistent source of primary care; access to referral services; and delivery of high-quality health care services.

Access to Insurance

Reduced access to health care results primarily from higher uninsured rates, and racial/ethnic minorities are more likely to be uninsured. States are trying many ways to reach out to people eligible for insurance coverage, as evidenced by Arizona's efforts.

Access to Services

Having health insurance does not equal access. Getting in the door of a provider's office does not equal receiving services that one needs and may have nothing to do with the intensity or the quality of the services provided.

Access to Providers

Lack of minority representation in the workforce can lead to policies, procedures, and care providers not equipped to care for diverse client populations or to understand sociocultural variations in health beliefs and behaviors. These barriers can be minimized through diversity in recruitment and training of the leadership and workforce.

Access to Information

Consumers who make informed choices of plan, provider, and treatment options are more likely to use appropriate health services, which may, in turn, produce better outcomes. Informing consumers about appropriate use of health services is a daunting task, but it can be done. Similarly, self-advocacy skills are difficult to develop, but education and training can help.

Cultural Competence

Various racial and ethnic populations view their ability to receive quality health care very differently; minority Americans are more likely to perceive themselves to be at a disadvantage because of their race. Cultural competence in the provision of care can minimize the perception of disadvantage.

Assisting Communities

Government entities committed to reducing racial disparities must consider how a new program or policy will affect racial/ethnic minorities. Various strategies to gauge the impact of programs and policies on these populations exist, as do methods for implementing successful efforts. Two State projects and one national program are described.

Ensuring Quality

Managed care organizations (MCOs) can serve as catalysts for quality improvement but face several challenges to focusing on disparities. However, it is legal and technically possible to collect and analyze member data by race/ethnicity in order to improve performance. It is also possible to make and measure improvements in cultural and linguistic appropriateness in service delivery.

Collecting and Using Data

Accurate and comprehensive data allow policymakers and program planners to better understand what is causing disparities within their jurisdictions. Data analysis can identify target areas and provide baseline data against which interventions can be monitored to evaluate success. Cooperation between entities can increase the ability of each one to get its questions answered.

Using Purchasing Power

States and other purchasers can use contracts with MCOs to reduce racial and ethnic disparities. California developed a series of Policy Letters for MCOs contracted to serve MediCal beneficiaries. One MCO's implementation strategies are described.

AHRQ's User Liaison Program (ULP) disseminates health services research findings in easily understandable and usable formats through interactive workshops. Workshops and other support are planned to meet the needs of Federal, State, and local policymakers, and other health services research users, such as purchasers, administrators, and health plans.

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