Eliminating Disparities in Children's Health Care Will Require Broad Quality Improvement Effort

New York City, September 14, 2004—Eliminating disparities in health care for minority children will take a concerted quality improvement effort throughout the fragmented U.S. health care system, best overseen by a national body housed within the Department of Health and Human Services, says an article in the September/October issue of Health Affairs.

In "Policies to Reduce Racial and Ethnic Disparities in Child Health and Health Care," Commonwealth Fund Senior Program Officer Anne C. Beal, M.D., details a strategy to eliminate pervasive disparities in the care received by children of color in the U.S. compared with white children while improving quality of care for all children. Key elements in any effort to achieve high quality care for all children, she writes, include increasing children's enrollment in public insurance programs, improving quality of care for beneficiaries enrolled in public programs and for patients who receive care from safety net providers, collecting data on disparities and monitoring progress to eliminate them, and training providers to treat an increasingly diverse patient population as well as increasing the diversity of the health care workforce to reflect the patient population.

Beal outlines specific areas where focusing on improvements in children's health care would be most effective in reducing disparities in care for children:

Public Insurance Programs: Improving coverage for eligible children in Medicaid and CHIP would improve access to care for many of uninsured children; fewer than half of eligible children are estimated to be currently enrolled in the Children's Health Insurance Program (CHIP). Further, eliminating gaps in care and improving quality of care for children in public programs will benefit African-American and Hispanic children, who are more likely than white children to be covered by public health insurance. Recent research indicates the quality of care for children in public programs does not match that found for children covered by private insurance plans.

Community Health Centers: Use successful community health centers' (CHCs) Health Disparities Collaboratives as models to focus on more children's health conditions. CHCs provide good-quality health care, with outcomes comparable to those in private settings; more than 65 percent of CHC patients are people of color.

Private Physicians' Practices. Disparities in care for children in private settings should be monitored. The majority of children of color get their care in private physicians' offices, but no data on quality of care according to race and ethnicity are collected in these settings.

Quality Measures. Widely used measures of quality such as the Health Plan Employer and Data Information Set (HEDIS), the Consumer Assessment of Health Plans (CAHPS), and quality indicators used by the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), and the National Quality Forum (NQF), should all report data by race and ethnicity. Using these measures to report disparities will let health systems and providers target areas for improvement.

Improve cultural competency. Medical students, residents, and other health professionals in training could be assisted in providing culturally competent care to an increasingly diverse patient population by incorporating curriculum on improving cross-cultural interactions and communications. Physicians in practice could also be offered training in cultural competency as part of professional re-certification or license renewal.

Increase diversity in the medical professions. Help improve diversity in the health care professions by providing adequate federal support for the HRSA Health Careers Opportunity Program, Centers of Excellence, and Minority Faculty Fellowship programs.

One way to increase health care workforce diversity is to encourage young people in communities affected by health disparities to become health care providers. Beal proposes that communities with documented disparities and poor school performance be designated "Health and Education Empowerment Zones," receiving additional federal support under the No Child left Behind Act of 2001 to expand and enrich science and health curricula.

Citing the need for federal oversight, Beal concludes that "whether the issue is health care coverage; quality measures; or advances in workforce diversity, regulations, or accreditation that reduce disparities, the number of initiatives and the magnitude of health disparities require coordination to promote the most effective intervention." She asserts that a federal health disparities advisory council would ensure that children's "unique needs and challenges are addressed within all federal efforts to eliminate disparities."