The June issue of Health Affairs, a theme issue, explores the pursuit of health equity and the obligations of the health care sector to achieve it. The issue examines the subject from two perspectives: equity in care, and the relationship between social factors and health equity.
The issue was supported by The Kresge Foundation, The California Endowment, Aetna Foundation, The Colorado Health Foundation, Episcopal Health Foundation, and the Robert Wood Johnson Foundation.
US virtually tops list of countries with highest health and health care disparities across income levels
Comparing health and health care disparities in the United States to those in thirty-one other high- and middle-income countries, Joachim Hero and colleagues of Harvard University found that the United States consistently reported high disparities across self-reported health and health care measures. Using International Social Survey Programme data, the researchers found that 38.2 percent of respondents in the bottom third of US incomes reported fair or poor health, compared to 12.3 percent for those in the top third. This places the United States at the third-highest disparity rating, behind just Chile and Portugal. Additionally, 67 percent of US respondents believed that "many" people in the country do not have access to the health care they need. Fifty-four percent believed that it is unfair that people with higher incomes can afford better health care than people with lower incomes. The authors caution against any policy change that threatens insurance gains seen since the Affordable Care Act's implementation, as such a change could reverse any improvement in income-based health care disparities that may have followed the implementation.
Efforts to improve racial disparity in surgical care show progress
Looking at thirty-day postoperative mortality rates in black and white patients for both high- and low-risk surgical procedures, Winta Tsegay Mehtsun and coauthors of Harvard University saw an overall improvement in mortality trends for both patient subsets in the period 2005–14. In the study period, mortality rates decreased for both black and white patients (by 0.10 percent per year and 0.07 percent per year, respectively), significantly narrowing the mortality rate disparity. The analysis also showed that small and medium-size hospitals had the greatest improvements in the mortality rates of black patients. While a complex interplay of factors contributes to racial disparities in surgical care—including inadequate access to timely care and delayed referrals among blacks—the authors are encouraged that broad-based quality improvement efforts have resulted in overall reductions in disparities. However, where residual disparities still exist, the authors believe that approaches targeted to minority patients may be necessary.
Kidney allocation program reduced disparity in transplantation rates
The United Network for Organ Sharing's kidney allocation system that was implemented in 2014 was found to have narrowed disparities between black, Hispanic, and white patients (see the exhibit below). Examining data from nearly 180,000 kidney transplant waiting list records from June 2013 to September 2016, Taylor Melanson of Emory University and coauthors found that after implementation, monthly transplantation rates changed significantly in favor of disparity reduction across all racial/ethnic groups, with the final rates 0.95 percent for whites, 0.96 percent for blacks, and 0.91 percent for Hispanics. This shows a substantial increase in kidney transplantation rates for blacks and Hispanics following the program's implementation, from 0.80 percent and 0.79 percent, respectively. Because this system represents an important step toward achieving equitable access to kidney transplantation, the authors urge others to take this example of valuable national policy change that can immediately reduce racial disparities and apply it to other aspects of the health care system.
Housing assistance associated with improved access to health care
Analyzing data from the National Health Interview Survey linked to administrative data from the US Department of Housing and Urban Development (HUD), Alan Simon of the US Department of Health and Human Services and coauthors observed the relationship between HUD housing assistance and the percentage of nondisabled people ages 18–64 that were uninsured and had unmet need for care. The researchers found that of those receiving assistance, 31.8 percent were uninsured, and 40.0 percent reported unmet need due to cost of care. In comparison, 37.2 percent of those who were not receiving HUD housing assistance, but would within twenty-four months of the survey, were uninsured, and 47.8 percent reported an unmet health need. The authors conclude that receiving HUD housing assistance is associated with a greater likelihood of being insured and having health needs met, but they suggest that more research could be done on the downstream effects of housing assistance on other measures of access to and use of health care.
Also of interest:
- Impact Of Ambulance Diversion: Black Patients With Acute Myocardial Infarction Had Higher Mortality Than Whites; Renee Hsia of the University of California, San Francisco, and coauthors.
- DATAWATCH: For Selected Services, Blacks And Hispanics More Likely To Receive Low-Value Care Than Whites; William Schpero of the Yale School of Public Health and coauthors.
Amenable death in Europe: Health care expenditure decreases mortality rates
An analysis of amenable mortality rates—the rates of deaths that are potentially preventable with available health care treatment options—in seventeen European countries, found that higher health care expenditure was associated with lower amenable mortality and with smaller absolute inequalities in amenable mortality. Johan Mackenbach of Erasmus University Medical Center and coauthors used country-level data on mortality by level of education for the period 1980–2010 to determine that mortality from conditions amenable to health care has declined strongly over time for women and men in all education groups (see the exhibit below). For all amenable causes combined (including tuberculosis, asthma, appendicitis, and certain cancers), the estimated annual mortality decline was 3.5 percent for highly educated men versus 2.2 percent for men with lower education levels. The declines for women were 3.3 percent and 2.1 percent, respectively. The data also indicated that an increase in health care expenditure's share of GDP was associated with a reduction of absolute inequalities in amenable mortality among men and women. The authors conclude that European health care systems were successful in reducing mortality from conditions amenable to health care among people at low education levels. This conclusion lends important support to the idea that health care can be an effective policy instrument for reducing health and mortality inequalities.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2rY0HjI
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