Dealing with Disparities: One of the Real Measures of Success by Dr. Alice Coombs

Since this blog began, articles have appeared on affordability, eligibility, what businesses must do, insurers' and policymakers' perspectives, physician shortages, and congratulatory pieces on how far we've come to lead the nation in health care access for all citizens.

There's been little written, however, on how this health care revolution will address one of our state's most pressing problems: health care disparities.

Chapter 58 states that "There shall be a health disparities council, located within, but not subject to the control of, the executive office of health and human services. The council shall make recommendations regarding reduction and elimination of racial and ethnic disparities in health care and health outcomes within the commonwealth…..The council shall address diversity in the health care workforce, including, but not limited to, doctors, nurses and physician assistants, and shall make recommendations on methods to increase the health care workforce…."

The Institute of Medicine's 2002 landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare," revealed that racial and ethnic minorities receive poorer quality medical care compared to white patients, even when such factors as insurance coverage, ability to pay and access to care were equivalent among the groups. (My emphasis added.)

We live in an area offering some of the best health care in the world. Yet we have growing problems with access to care: the number of primary care providers is shrinking and many physician specialties, such as neurosurgery, anesthesiology, radiology, cardiology, and general surgery, remain in short supply.

Minority patients are more affected by these shortages, because primary care providers are less available and the wait times for routine exams and preventive care are longer. Because of this situation, crucial diagnoses may be missed and delayed. And with delay, the severity of the illness is much greater when patients first present.

Massachusetts fared well in the Commonwealth Fund's recent State Scorecard on Health System Performance. Despite ranking 8th overall, however, Massachusetts had some eye-popping statistics: (1) The percentage of uninsured individuals age 0-64 was 10.4% for whites, 15.6% for Blacks, and 22% for Hispanics; and (2) The percentage of children age 0-17 who went without a medical and dental preventive care check-up within the past year was 20.9% for whites, 34.7% for Blacks, and 40.5% for Hispanics.

Despite our reputation for health care and progress in universal coverage, racial and ethnic disparities exist in health care. The causes are many: the culture from which the patient comes, healthcare provider awareness of the differences in treatments for different groups, workforce diversity, the level of health care literacy and communication between physicians and patients, biological differences among groups, lack of translation services for those deficient in English language skills, and the social and economic levels of the patients, to name several.

We also have problems with recruitment and retention of physicians who want to serve underrepresented groups - a subset of a major problem affecting overall health care in the Commonwealth, as noted for several years by the Massachusetts Medical Society in itsannual workforce studies.

There is good news, however. Providers, insurers, hospitals, policymakers, and legislators have recognized that disparities must be eliminated. The City of Boston, the Boston Public Health Commission, the Commonwealth, Health Care for All, the Massachusetts Medical Society and the American Medical Association are devoting resources and taking steps to address the problems of disparities.

These groups can contribute mightily to the health disparities council, and it would be in the state's best interests for the health disparities council to reach out to them for what they have learned and the actions they're now taking to reduce disparities in health care.

We can congratulate ourselves on the progress we've made and continue to talk about affordability and keeping a lid on costs. We can work to address the issues of physician shortages and access. But we must constantly remind ourselves that insurance doesn't guarantee access, and that one of the real measures of success in Massachusetts health care reform will be how we take care of all of our diverse populations.

Alice A. Tolbert Coombs, M.D., is Assistant Secretary Treasurer of the Massachusetts Medical Society, a critical care specialist and anesthesiologist at South Shore Hospital, and immediate past chair of the Medical Society's Committee on Diversity in Medicine. She is also a member of the American Medical Association's Committee to End Health Care Disparities and Chair of the Workforce Diversity Committee of the Commonwealth's Commission to Eliminate Racial and Ethnic Disparities in Health Care.