Equal access, equal care
WE KNOW that infant mortality rates of African-Americans eclipse those of other ethnic groups; that Latinos die from asthma at a rate four times higher than whites and, from a recent Harvard study, that unconscious racial bias affects the way doctors care for African-American heart attack victims. We do not know why.
There are social and economic costs of inequities in quality of healthcare.
Disparities result in the loss of millions of dollars each year in additional expenditures and lost productivity due to poorly managed care, complications, delayed diagnoses and treatment, and misdiagnoses.
Often, underserved populations need greater support and a different approach to health education to use the healthcare system effectively and advocate for their rights. Provision of broader health insurance coverage (as with our healthcare reform effort) is an important component of providing access to services, but does not ensure access to services that are delivered in a culturally competent, linguistically appropriate manner.
In order to figure out the full breadth of healthcare disparities, and why they exist and what can be done to eliminate them, we must address a critical, yet controversial issue: the gathering of race and ethnicity data on medical patients.
Collection of such data can raise difficult issues such as fear of prejudice, selective treatment, and profiling. However, it is the only way to accurately define the problem and convince the public and healthcare providers that disparities do indeed exist.
The Commonwealth is actively taking steps to address this issue. The Health Care Quality and Cost Council will require all health insurance companies to begin gathering and reporting quality and performance measures by next spring. Both health insurers and hospitals will be required to show they are reducing racial and ethnic disparities in the delivery of healthcare. The Massachusetts Joint Legislative Commission to Eliminate Racial and Ethnic Health Disparities will release its report soon and a special council mandated by the state's healthcare reform law will be convened this fall to carry on the commission's work.
Neighborhood Health Plan and the Massachusetts League of Community Health Centers have already made noteworthy progress in this area. With a decades-long track record of working with racially and ethnically diverse patient populations, we launched a partnership more than two years ago to establish a system for collecting such data from our members and patients.
Our efforts have replicated the finding that African-American women are less likely to receive mammogram screenings than white women.
We've also found that differences exist between the care diabetic Puerto Ricans receive compared with Dominicans. And that Latinos as a whole are less likely to refill medications and continue treatment for depression compared with other ethnic groups.
Armed with such information we are beginning to tackle the next layer of this multilayered challenge.
Sometimes it is as straightforward as getting the right information to patients in a format they can understand.
Other times it is addressing cultural norms on both the part of the healthcare provider and the patient that are interfering with care.
As the state develops regulations for health plans to begin the collection of race and ethnicity data, we offer this advice:
Build upon existing relationships with clinical care givers familiar with serving racially and ethnically diverse populations.
Aim to help overcome fears of discrimination or profiling.
Demonstrate the highest ethics in any data collection by limiting how these data are used and for what purposes.
Collaborate with healthcare providers and community organizations to bridge the gaps where disparities exist.
By establishing a careful, broad-based data collection system, Massachusetts will build a resource not only to identify specific healthcare disparities, but also to make progress in determining why they exist.
If we can answer that question, Massachusetts can take great pride in providing truly comprehensive access to quality, efficient care -- regardless of race, ethnicity, or socioeconomic differences.
Dr. Paul Mendis is chief medical officer of the Neighborhood Health Plan and a member of the Joint Legislative Commission to Eliminate Racial and Ethnic Health Disparities. Dr. James O'Connell is chairman of the Clinical Issues Committee at the Massachusetts League of Community Health Centers and president of the Boston Health Care For the Homeless. 
