Physician Focus: Eliminating Disparities in Care
By Ronald Dunlap, M.D. and Milagros Abreu, M.D., M.P.H.
Twelve years ago, the Institute of Medicine, the independent health arm of the National Academy of Sciences, issued a groundbreaking report on health care and racial and ethnic minorities.
That report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, disclosed wide differences between minorities and whites in the quality of care they receive. The report made public a topic that today still commands the attention of the medical community, and it becomes more important as our population continues to undergo demographic changes.
It's important here to distinguish between health disparities and health care disparities.
Health disparities are the differences in the incidence or prevalence of disease between genders or ethnic or racial groups. As examples, heart disease affects men and women in different ways, and African Americans are known to have higher average blood pressure than whites.? These are natural occurrences.
Health care disparities, however, represent the differences in care that's delivered for a certain condition. Two people, for example, with the same disease at the same severity, would receive different levels of care, even when insurance, income, age, and medical conditions are comparable.
The significance of disparities in care is obvious: they negatively affect patients” health. A minority patient with high blood pressure, for example, but lacking regular care will discover it later, when the condition and potentially preventable secondary complications from it are worse.? Likewise, a woman with breast cancer may learn of her illness in the later stages of the disease after the cancer has spread, making treatment more difficult and survival worse. Both examples mean more severe complications and poorer health outcomes for the patient and higher costs for treatment.
Bridging the communication gap is a critical first step in reducing disparities. Sometimes, providers subject themselves to an unwitting or subconscious bias because of their inability to communicate well with patients. Patients and physicians must find common ground; this allows a sense of trust to develop between provider and patient and enables patients to be engaged in their care.
Finding common ground includes eliminating cultural differences between provider and patient. A provider's inability to understand a patient's culture – diet, habits, values, customs, lifestyles – can be a major issue. Providers are urged to attain what is called “cultural competency,” described by The Office of Minority Health of the U.S. Department of Health and Human Services as one of the main ingredients in closing the disparities gap in health care. “Quite simply,” OMH says, “health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes.”
Economics also plays a role. The number of providers in a community, for example, may be limited by that community's social and economic characteristics.? Some medical providers may choose not to practice in a community because it's not as profitable or because the payment systems for providers are so poor that it's not viable to maintain a medical practice there. Thus, even with universal care here in Massachusetts, patients may have a harder time finding a provider simply because fewer of them are in the community.
Progress is being made, however.? Hospitals and medical practices are developing systems and protocols to ensure everyone gets the benefit of the best services for a given condition.? Technology can also be useful, as smart phone applications will help patients adhere to treatment plans and put patients more in charge of their own care.
Both providers and patients must act. Our message for patients is to be active in your care, improve your health literacy, seek information from community groups about how to access care, look for providers that will work with you, and understand your diagnoses and what you can do to affect your health.
Our message for providers is to be conscious that disparities in care do exist, work to attain a greater cultural competency, and understand the community you serve. ?The development of care plans and improving the quality of care for a given disorder will also help to make treatment plans more uniform for the entire population.
Patients and providers working together, engaged in shared decision-making, is the best way to reduce disparities in care. For more information, visit the Massachusetts Medical Society at www.massmed.org/disparities or the Latino Health Insurance Program at www.lhiprogram.org. For a video discussion, visit www.physicianfocus.org/healthdisparities.
Ronald Dunlap, M.D., a physician with South Shore Cardiology in Weymouth, is President of the Massachusetts Medical Society. Milagros Abreu, M.D., M.P.H., is Vice Chair of the MMS Committee on Diversity in Medicine and Founder and President of the Latino Health Insurance Program in Framingham, Mass.? Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org
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