The Centers for Disease Control and Prevention (CDC) identifies health disparities as "preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health experienced by socially disadvantaged populations."
Although inequities exist across a broad spectrum of factors, including race, gender, sexual orientation, disabilities, and socioeconomic status, the healthcare differential between blacks and whites is significant. And the recognition of these inequities is not new, as two Surgeon General's reports documented disparities in tobacco use and access to mental health care by race and ethnicity as far back as the 2000s. Since then, other studies support that people of color experience more negative health outcomes than whites across various measures, including infant mortality, pregnancy-related deaths, prevalence of chronic conditions, overall physical and mental health status, and lower life expectancy. Some of this is due to a gap in insurance coverage, with 11.2% of blacks lacking insurance versus 7.2% of whites. While the Affordable Health Care Act led to significant gains in minority coverage, much of that progress was eroded by a range of actions by the Trump administration, including decreased funding for outreach and enrollment assistance and new eligibility restrictions on Medicaid coverage.
While the most significant impact of disparities affects individuals and families, there is also a tremendous financial cost estimated at approximately $93 billion in excess medical care costs, $42 billion in lost productivity per year, and additional economic losses associated with premature deaths. But there are ways to address this persistent inequality. BCT Partners, a company dedicated to creating lasting change, illustrates how policy changes, technology, and advocacy can increase access to higher quality care for all Americans.
1) Expanding Vaccine Access
HHS is investing nearly $10 billion to expand access to vaccines and better serve communities of color, rural areas, low-income populations, and other underserved communities. This includes $6 billion to be provided to community health centers, which have been vaccinating more significant numbers of minorities compared to other available options.
2) Addressing Racism in Biomedical Research
The National Institutes of Health (NIH) launched the UNITE Initiative to address structural racism and racial inequities in biomedical research. Five committees with experts from all 27 NIH institutes and centers will recommend ways to increase racial diversity, equity, and inclusion. NIH will also seek advice and guidance from outside the agency through the Advisory Committee to the Director (ACD) and a Request for Information (RFI) that requests input from the public and stakeholder organizations.
3) Increasing Access to Insurance
President Biden issued an Executive Order to Strengthen Medicaid and the Affordable Care Act by establishing a special open enrollment period for the Health Insurance Marketplaces and directed federal agencies to review policies and practices to ensure they support access to health coverage.
4) Enhancing Subsidies and Removing Barriers to Eligibility
The American Rescue Plan Act also contains provisions designed to enhance access to health coverage and affordability through increases and expansions in eligibility for subsidies to buy insurance through Marketplaces. 360,000 uninsured black and African Americans will be newly eligible to save money on health care coverage, and 328,000 will be eligible for zero-dollar benchmark Marketplace plans. The administration has also put in place Medicaid provisions that offer states incentives to encourage the adoption of the ACA Medicaid expansion.
5) Prioritizing Maternal Health
The Centers for Medicare and Medicaid Services (CMS) approved several state waivers to extend the Medicaid postpartum coverage period. The Human Resources and Services Administration also announced $12 million in awards for the Rural Maternal and Obstetrics Management Strategies Program, designed to develop models and implement strategies to improve maternal health in rural communities.
6) Increasing Access to Telehealth
With the outbreak of COVID, many patients "visited" their doctor remotely for the first time. For patients who are disabled, can't take time off from work, or don't have good transportation options, telehealth increases their ability to access care. And new research from the University of Pennsylvania supports that by validating black patients are more likely to keep appointments with their physician when offered a remote option. The study shows that the sharp rise in telemedicine appointments appears to have eliminated a historical racial health gap in appointment show rates between Black and white patients in a Philadelphia health system. Post-discharge primary care visit completion rates for Black patients' increased from 52% to 70%, thereby highlighting the potential that telehealth has for bridging long-standing health inequities.
7) Increasing Technology Adoption
Doctors spend less than a third (27%) of their time treating patients; most of their time is spent on various administrative tasks. In fact, some doctors spend up to one-third of their time just entering patient notes into electronic health records (EHRs). Artificial intelligence (AI) and software can limit—even automate—physician interactions with electronic health records, provide prescription advice and reminders, and help physicians avoid excessive testing. Broadening the use of technology will allow more time with patients versus administrative tasks.
8) Encouraging Patient Advocacy
Patients need to feel confident in taking a more active role in their own care. Whether it be researching options for care, getting a second or third opinion, or taking advantage of remote patient monitoring, they need to understand their rights. Many minorities and elderly patients do not feel comfortable questioning anything their doctor tells them. However, with increased education, patients can start feeling confident in taking more control and even seeking out other physicians if they are unhappy with their care.
9) Improving Care Coordination
The healthcare system in the United States has become so decentralized and specialized that many patients must see multiple doctors to get adequate care. This means increased doctor's visits, navigating complexities with insurance, and concerns that care among the various physicians is not appropriately coordinated. The U.S. needs a new type of care worker supported by technology to help patients coordinate between health professionals, social care, and human services.
10) Increasing the Number of Physicians of Color
African Americans comprise 13% of the U.S. population, but only 4% of U.S. doctors and less than 7% of U.S. medical students. Research has found that physicians of color are more likely to treat minority patients, practice in underserved communities, and increase patient trust. Another study found that black men were more likely to seek preventative services when seen by black doctors. For example, participants assigned to black doctors were likelier to have their blood pressure and BMI measured than those who saw non-black doctors. A participant who saw a black doctor was 20 percentage points (47%) more likely to agree to a diabetes screening and 26 percentage points (72%) more likely to accept a cholesterol screening than those who saw a non-black doctor. This study supports the push to increase diversity in the healthcare workforce. And while many patients prefer to interact with doctors of the same background — researchers advise against interpreting these results to mean that black patients should only be treated by black physicians and white patients should only be treated by white physicians. "Dr. Anupam Jena, a physician at MGH and an economist affiliated with NBER, urged similar caution. However, he said, "Doctors should be aware that empathy and understanding of your patient, perhaps through shared experiences, might have an important causal impact on health."
Through policy changes, technology, and advocacy, we can significantly decrease healthcare disparities. While there is still a long way to go, it's encouraging to see the Biden administration making this a top priority by implementing policies that create lasting change. Because without healthcare equity, there is no equity.
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