An outline of the presentation by Marilyn Hughes Gaston, MD
May 23, 2006
Recognition of the problem of healthcare disparities is not new. Dr. Martin Luther King, Jr. over 40 years ago noted, “No area of injustice and shame is as great as in the area of health.” Strides have been made, but in many areas healthcare disparities and its impact on the health of individuals and certain patient populations still exist.
There is a continued disparity between the poor and non-poor; and due to race, ethnicity, gender and geography. In some areas healthcare outcomes are improving for all patients (heart disease, cancer, stroke, smoking, improvement in self-care), but in other areas disparities are becoming worse (asthma, diabetes, mental health and obesity).
Factors that influence healthcare outcomes at the population level include:
- Barriers to access to care
- The dysfunctional U.S. health care system
- Unequal quality of treatment
- Socioeconomic/cultural and language aspects
Factors influencing these outcomes at the individual level include:
- Lifestyle choices
- Genetics
- Education
- Low health literacy
- Attitudes toward healthcare of individual patients
To reduce disparities, equal access is needed to:
- Quality care
- Affordable medications
- Medical information
Financial barriers to equal access to care include:
- Poverty
- The lack of healthcare insurance
- In the US there are an estimate 45 million uninsured for entire year
- There are an estimated 70 million uninsured for part of year
- The under-insured cost the healthcare system millions of dollars; according to the Institute of Medicine, the lack of insurance is the 5th leading cause of death.
There are racial disparities in uninsured populations. In 2004 in Florida:
- 18% of whites were uninsured
- 26% of African-American were uninsured
- 41% of Hispanics were uninsured
A lack of insurance affects the care patients receive. In 2000 the difference in use of services related to:
- Routine Exams - Insured 70% - Uninsured 47%
- Pap smears - Insured 76% - Uninsured 49%
- Mammograms - Insured 40% - Uninsured 16%
- Prostate exams - Insured 20% - Uninsured 12%
There is a significant difference in the stage of diagnosis of breast cancer between the insured and uninsured.
The broken health care system is evidenced by:
- The lack of coordination and fragmentation of services in our current system
- Reports that the quality of care needs improving overall
- Discrimination, bias and prejudices that continue to persist
- Too much focus on treatment, and not enough on prevention
- Too few minority providers
Solutions offered include:
A more primary care centered health system. The Galveston Texas Primary Care Centered Health System is one model of a successful system. These systems typically:
- Utilize community-owned boards
- Address all barriers to care
- Have patient population that are
- 85% poor and near-poor
- 70% minority
- 41% uninsured
- 33% Medicaid
Studies have shown that users of a Primary Health System model have:
- Lower odds of being hospitalized for an ambulatory care sensitive condition
- 3 times better chance of blood pressure control
- Significant reductions in HbA1C averages
- Children with average higher birth weights
- Detection of breast cancer at significantly earlier stages
Implementation and the success of a Primary Health System are based on widespread involvement and support from all healthcare providers within a given area.
Return to SCMS Meetings
Comments