Over the past decade, the body of evidence documenting disparities in access to and quality of health care has been growing. Many studies show that, even among insured individuals with the same health coverage, racial and ethnic disparities exist, with minorities generally faring worse than majority groups.
In response, health organizations have begun to take steps to identify disparities in their own patient populations. In 1998, The Commonwealth Fund supported the Minority Health Report Card Project, which developed quality of care measures to identify such disparities. In 2000, this "report card" was pilot-tested in eight health plans serving large minority populations to see if it was possible to collect data on race and ethnicity of patients and to assess health care data stratified by race and ethnicity.
The results are documented in a new Fund report, Developing a Health Plan Report Card on Quality of Care for Minority Populations,, by David R. Nerenz, Margaret J. Gunter, Magda Garcia, Robbya R. Green-Weir, Kimberlydawn Wisdom, and Christine Joseph.
All eight plans were able to obtain data on the race and ethnicity of their members without significant difficulty. They used one or more of the following methods: Medicaid enrollment files, medical record data, self-report items in surveys, and surname-recognition software.
Analysis of this data was quite revealing. Disparities of five percentage points or statistically significant differences of smaller absolute magnitude were found in more than half of the comparisons of Health Plan Employer Data and Information Set (HEDIS) quality measures.
Disparities were also found for several comparisons of Consumer Assessment of Health Plans Survey (CAHPS) scores. Some showed consistently lower scores for African American respondents than Caucasians, but reports of disparities was generally mixed. In fact, minority groups sometimes reported higher ratings-perhaps a reflection of participating plans' commitment to serving minority patients.
Such variations provide an impetus for health plans to assess and monitor health care quality. Analyzing data by race and ethnicity, the authors conclude, is the lynchpin in efforts to improve quality and eliminate disparities in health care.
Facts and Figures
- In one health plan, only 20 percent of African American children with asthma received appropriate follow-up care after an acute episode, compared with 40 percent for Caucasian children.
- Filipinos and Native Hawaiians in one health plan had significantly lower rates of breast cancer screening than Caucasians (72% and 75% vs. 81%).
- More Hispanics than non-Hispanics with diabetes in one health plan said that their doctors discussed the complications of diabetes with them during all visits (58% vs. 35%).