Quality of Care and Health Disparities: The Evolving Role of the Government

Chapter

Abstract

Over the past 20–25 years, there has been a significant evolution in the role of the Federal government in addressing the problem of health disparities in the United States. In this chapter, the nature of health disparities among minorities and underserved populations in this country, and early governmental approaches to the problem are described in brief. A historical and descriptive overview of the government’s efforts, since 1985, to eliminate health disparities in the United States will be described as well as a description of the potential impact of health reform.

Keywords

National Health Disparities Report (NHDR) National Healthcare Quality Report (NHQR) Federal poverty level Indian Health Service (IHS) Tuskegee Syphilis Experiment Secretary’s Task Force Office of Minority Health (OMH) Centers for Disease Control and Prevention (CDC) Health Resources and Services Administration (HRSA) National Institutes of Health (NIH) Historically Black Colleges and Universities (HBCUs) National Institute on Minority Health and Health Disparities (NIMHD) Agency for Healthcare Research and Quality (AHRQ) 

References

  1. 1.
    Heckler MM. Report of the secretary’s task force on black and minority health. Executive summary. Washington, DC: US Department of Health and Human Services; 1985.Google Scholar
  2. 2.
    Health, United States. With chartbook on trends in the health of Americans. Hyattsville: National Center for Health Statistics; 2004.Google Scholar
  3. 3.
    National healthcare quality report [NHQR 2009]. Rockville: Agency for Healthcare Research and Quality. 2009. http://qualitytools.ahrq.gov/qualityreport/archive/2003/browse/browse.aspx. Accessed 28 July 2010.
  4. 4.
    National healthcare quality report [NHQR 2009]. Rockville: Agency for Healthcare Research and Quality, Rockville. 2009. http://qualitytools.ahrq.gov/qualityreport/browse/browse.aspx. Accessed 27 July 2010.
  5. 5.
    Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med. 2005;353:692–700.PubMedCrossRefGoogle Scholar
  6. 6.
    National healthcare disparities report [NHDR 2009]. Rockville: Agency for Healthcare Research and Quality, Rockville. 2009. http://qualitytools.ahrq.gov/disparitiesreport/archive/2009/download/download_report.aspx). Accessed 1 Aug 2010.
  7. 7.
    National healthcare disparities report [NHDR 2009]. Rockville: Agency for Healthcare Research and Quality. 2009. http://qualitytools.ahrq.gov/disparitiesreport/browse/browse.aspx. Accessed 1 Aug 2010.
  8. 8.
    Smedley BD, Stith AR, Nelson AC, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.Google Scholar
  9. 9.
    Health care: approaches to address racial and ethnic disparities (2003). Washington, DC: United States General Accounting Office, GAO publication no. 03-862R Health care disparities.Google Scholar
  10. 10.
    Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347:1585–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Eliminating racial & ethnic health disparities. Atlanta: Centers for Disease Control and Prevention, Office of Minority Health. 2005. http://www.cdc.gov/omh/AboutUs/disparities.htm. Accessed 23 Sept 2005.
  12. 12.
    “If you knew the conditions…” Health care to Native Americans. Bethesda: US National Library of Medicine. 1998. http://www.nlm.nih.gov/exhibition/if_you_knew/if_you_knew_01.html. Accessed 4 Oct 2005.
  13. 13.
    Indian Health Service fact sheet. Rockville: Department of Health and Human Services, Indian Health Services. 2005. http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/ThisFacts.asp. Accessed 3 Oct 2005.
  14. 14.
    Statement by Mike Leavitt Secretary of Health and Human Services regarding the 50th anniversary of the Indian Health Service. Washington, DC: US Department of Health and Human Services. 2005. http://www.hhs.gov/news/press/2005pres/20050804.html. Accessed 4 Oct 2005.
  15. 15.
    Tuskegee syphilis story. Atlanta: Centers for Disease Control and Prevention, The National Center for HIV, STD, and TB Prevention. 2005. http://www.cdc.gov/nchstp/od/tuskegee/. Accessed 3 Oct 2005.
  16. 16.
    The Tuskegee timeline. Atlanta: Centers for Disease Control and Prevention, The National Center for HIV, STD, and TB Prevention. 2005. http://www.cdc.gov/nchstp/od/tuskegee/time.htm. Accessed 3 Oct 2005.
  17. 17.
    The troubling legacy of the Tuskegee syphilis study. Charlottesville: University of Virginia Health System. 2003. http://www.med.virginia.edu/hs-library/historical/apology/. Accessed 3 Oct 2005.
  18. 18.
    Coming to terms with the legacy of the Tuskegee syphilis study. Charlottesville: University of Virginia Health System. 2003. http://www.med.virginia.edu/hs-library/historical/apology/symp.html. Accessed 3 Oct 2005.
  19. 19.
    Tuskegee University National Center for Bioethics. Tuskegee: Tuskegee University. 2005. http://www.tuskegee.edu/Global/category.asp?C=35026. Accessed 3 Oct 2005.
  20. 20.
    How Tuskegee changed research practices. Atlanta: Centers for Disease Control and Prevention, The National Center for HIV, STD, and TB Prevention. 2005. http://www.cdc.gov/nchstp/od/tuskegee/after.htm. Accessed 3 Oct 2005.
  21. 21.
    About OMH. Rockville: Department of Health and Human Services, Office of Minority Health. 2010. http://www.minorityhealth.hh.gov/OMH/sidebar/aboutOMH.htm. Accessed 28 July 2010.
  22. 22.
    OMH home page. Rockville: Department of Health and Human Services, Office of Minority Health. 2010. http://www.minorityhealth.hhs.gov/. Accessed 28 July 2010.
  23. 23.
    OMHRC home page. Rockville: Department of Health and Human Services, Office of Minority Health. 2010. http://www.omhrc.gov/OMHRC/index.htm. Accessed 28 July 2010.
  24. 24.
    Healthy People home page. Rockville: Department of Health and Human Services, Office of Disease Prevention and Health Promotion. 2010. http://www.healthypeople.gov/default.htm. Accessed 28 July 2010.
  25. 25.
    The Center for Linguistic and Cultural Competence in Health Care. Cultural competence. Rockville: Department of Health and Human Services, Office of Office of Minority Health. 2005. http://www.omhrc.gov/cultural/index.htm. Accessed 24 Sept 2005.
  26. 26.
    CDC – our story. Atlanta: Centers for Disease Control and Prevention. 2009. http://www.cdc.gov/about/ourstory.htm. Accessed 28 July 2010.
  27. 27.
    About minority health. Atlanta: Centers for Disease Control and Prevention, Office of Minority Health. 2005. http://www.cdc.gov/omh/AMH/AMH.htm. Accessed 1 Oct 2005.
  28. 28.
    About us. Atlanta: Centers for Disease Control and Prevention, Office of Minority Health. 2005. http://www.cdc.gov/omh/AboutUs/aboutUs.htm. Accessed 1 Oct 2005.
  29. 29.
    Eliminate disparities in cancer screening & management. Atlanta: Centers for Disease Control and Prevention, Office of Minority Health. 2005. http://www.cdc.gov/omh/AMH/factsheets/cancer.htm. Accessed 1 Oct 2005.
  30. 30.
    About HRSA. Rockville: Department of Health and Human Services, Health Resources and Services Administration. 2010. http://www.hrsa.gov/about.htm. Accessed 28 July 2010.
  31. 31.
    Community health centers. Rockville: Department of Health and Human Services, Health Resources and Services Administration. 2009. http://bphc.hrsa.gov/chc/default.htm. Accessed 28 July 2010.
  32. 32.
    Bureau of health professions. Rockville: Department of Health and Human Services, Health Resources and Services Administration. 2010. http://bhpr.hrsa.gov/. Accessed 28 July 2010.
  33. 33.
    Patient Protection and Affordable Care Act (P.L. 90-248), Washington, DC: United States Congress. 2010. http://www.govtrack.us/congress/bill.xpd?bill=h111-3590. Accessed 5 Aug 2010.
  34. 34.
    About NCMHD. Bethesda: Department of Health and Human Services, National Institutes of Health. 2010. http://ncmhd.nih.gov/about_ncmhd/mission.asp. Accessed 28 July 2010.
  35. 35.
    Supporting state offices of minority health. Closing the gap newsletter. Rockville: Department of Health and Human Services, Office of Minority Health. 2000. http://www.omhrc.gov/ctg/ctg_states.pdf. Accessed 30 Sept 2005.
  36. 36.
    Trivedi AN, Gibbs B, Nsiah-Jefferson L, Ayanian JZ, Prothrow-Stith D. Creating a state minority health policy report card. Health Aff. 2005;24:388–96.CrossRefGoogle Scholar
  37. 37.
    Assessment of State Minority Health Infrastructure and Capacity to Address Issues of Health Disparity. Rockville: Department of Health and Human Services, Office of Minority Health. 2001, 2003. http://www.omhrc.gov/OMH/Programs/2pgprograms/evaluations.htm and http://aspe.hhs.gov/pic/hilites/11-1.htm#2. Accessed 30 Sept 2005.
  38. 38.
    Reede J. A recurring theme: the need for minority physicians. Health Aff. 2003;22:91–3.CrossRefGoogle Scholar
  39. 39.
    Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff. 2000;19:76–83.CrossRefGoogle Scholar
  40. 40.
    Komaromy M, Grumbach K, Drake M, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334:1305–10.PubMedCrossRefGoogle Scholar
  41. 41.
    The White House initiative on Historically Black Colleges and Universities. Washington, DC: Department of Education. 2010. http://www2.ed.gov/about/inits/list/whhbcu/edlite-list.html. Accessed 30 July 2010.
  42. 42.
    Plans and reports. Rockville: Department of Health and Human Services, Office of Minority Health. 2009. http://www.omhrc.gov/omh/historically%20black/prs/prs_toc.htm. Accessed 30 July 2010.
  43. 43.
    Hispanic agenda for action. Rockville: Department of Health and Human Services, Office of Minority Health. 2001. http://www.omhrc.gov/haa/index.htm. Accessed 28 July 2010.
  44. 44.
    Tribal colleges and universities. Rockville: Department of Health and Human Services, Office of Minority Health. 2009. http://www.omhrc.gov/omh/tribal%20colleges/index.htm. Accessed 30 July 2010.
  45. 45.
    Asian American & Pacific Islander action agenda. Rockville: Department of Health and Human Services, Office of Minority Health. 2009. http://www.omhrc.gov/omh/Asian%20Americans/index.htm. Accessed 30 July 2010.
  46. 46.
    Healthcare Research and Quality Act of 1999 (P.L. 106–129), 113 Stat. 1653, 6 Dec 1999. Washington, DC: United States Congress. 1999. www.ahcpr.gov/hrqa99a.htm. Accessed 28 July 2010.
  47. 47.
    Reauthorization fact sheet. Rockville: Agency for Healthcare Research and Quality. 2005. http://www.ahcpr.gov/about/ahrqfact.htm. Accessed 26 Sept 2005.
  48. 48.
    Agency for Healthcare Research and Quality. AHRQ profile. Advancing excellence in health care. Rockville. 2005. http://www.ahcpr.gov/about/profile.htm. Accessed 26 Sept 2005.
  49. 49.
    Clancy CM. Perspective: back to the future. Health Aff. 2003. Web exclusive http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w3.314v1. Accessed 26 Sept 2005.
  50. 50.
    Lurie N, Jung M, Lavizzo-Mourey R. Disparities and quality improvement: federal policy levers. Health Aff. 2005;24:354–64.CrossRefGoogle Scholar
  51. 51.
    Kohn LT, Corrigan JM, Donaldson MS editors. To err is human. Building a safer health system. Washington, DC: National Academies Press; 2000. http://www.nap.edu/openbook/0309068371/html/. Accessed 28 July 2010.
  52. 52.
    Agency for Healthcare Research and Quality. Specific populations. Rockville. 2005. http://www.ahrq.gov/populations/. Accessed 26 Sept 2005.
  53. 53.
    Poker A, Hubbard H, Sharp BA. The first national reports on United States healthcare quality and disparities. J Nurs Care Qual. 2004;19:316–21.PubMedCrossRefGoogle Scholar
  54. 54.
    Moy M, Dayton E, Clancy CM. Compiling the evidence: the national healthcare disparities reports. Health Aff. 2005;24:376–87.CrossRefGoogle Scholar
  55. 55.
    The Health Plan Employer Data and Information Set (HEDIS). Washington, DC: The National Committee for Quality Assurance. 2005. http://www.ncqa.org/Programs/HEDIS/index.htm. Accessed 11 Oct 2005.
  56. 56.
    Diabetes Quality Improvement Project Initial Measure Set (Final Version). Washington, DC: The National Committee for Quality Assurance. 2010. http://www.ncqa.org/dprp/dqip2.htm. Accessed 28 July.
  57. 57.
    Bierman AS, Lurie N, Collins KS, Eisenberg JM. Addressing racial and ethnic barriers to effective health care: the need for better data. Health Aff. 2002;21:91–102.CrossRefGoogle Scholar
  58. 58.
    Office of the National Coordinator for Health Information Technology (ONCHIT). Rockville: Department of Health and Human Services. 2005. http://www.hhs.gov/healthit/. Accessed 11 Oct 2005.
  59. 59.
    Health Information Technology Leadership Panel: Final Report. Rockville. Department of Health and Human Services. 2005. http://www.healthfinder.gov/docs/doc09012.htm and http://www.omhrc.gov/inetpub/wwwroot/omhrc/pressreleases/2005press0511.htm. Accessed 11 Oct 2005.
  60. 60.
    Hsu J, Huang J, Kinsman J, et al. Use of e-health services between 1999 and 2002: a growing digital divide. J Am Med Inform Assoc. 2005;12:164–71.PubMedCrossRefGoogle Scholar
  61. 61.
    Cashen MS, Dykes P, Gerber B. eHealth technology and internet resources. Barriers for vulnerable populations. J Cardovasc Nurs. 2004;19:209–14.Google Scholar
  62. 62.
    Literacy and health outcomes (2003). Rockville: Agency for Healthcare Research and Quality, Evidence report/technology assessment, no. 87. 2003. http://www.ahrq.gov/clinic/epcsums/litsum.htm. Accessed 28 July 2010.
  63. 63.
    Betancourt JR, Green AR, Carrillo JE, Park ER. Cultural competence and health care disparities: key perspectives and trends. Health Aff. 2005;24:499–505.CrossRefGoogle Scholar
  64. 64.
    State resources for selected measures from the 2004 National healthcare quality report. Rockville: Agency for Healthcare Research and Quality. 2005. http://www.qualitytools.ahrq.gov/qualityreport/state/. Accessed 1 Oct 2005.
  65. 65.
    AHRQ National Resource Center for Health Information Technology. Rockville: Agency for Healthcare Research and Quality. 2010. http://healthit.ahrq.gov/home/index.html. Accessed July 2010.
  66. 66.
    Agency for Healthcare Research and Quality. Quality tools. Rockville. 2005. http://www.qualitytools.ahrq.gov/. Accessed 28 Sept 2005.

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.WashingtonUSA

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