Minority Health and Health Equity Archive

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The Contribution of Insurance Coverage and Community Resources to Reducing Racial/Ethnic Disparities in Access to Care
(2003) Hargraves, J. Lee; Hadley, Jack
Abstract available at publisher's web site.
Ethnic Disparities in Blood Pressure Management in Patients With Hypertension After the Introduction of Pay for Performance
(2008) Millett, Christopher; Gray, Jeremy; Bottle, Alex; Majeed, Azeem
PURPOSE Little is known about the impact of pay-for-performance incentives on health care disparities. We examined ethnic disparities in the management of hypertension among patients with and without cardiovascular comorbidities after the implementation of a major pay-for-performance incentive scheme in UK primary care. METHODS We undertook a population-based, cross-sectional survey of medication prescriptions and blood pressure control among patients with hypertension using electronic medical records from 16 family practices in southwest London. RESULTS Black patients with hypertension were signifi cantly less likely to achieve an established treatment target for blood pressure control than white or South Asian patients (adjusted odds ratio, 0.86; 95% confi dence interval, 0.74-0.99). The prevalence of cardiovascular comorbidities was higher among South Asian patients with hypertension than among their white or black counterparts (41.3% vs 28.5% vs 28.8%). The presence of 2 or more cardiovascular comorbidities was associated with signifi cantly improved blood pressure control among white patients but not among black or South Asian patients (mean systolic blood pressure, −9.4 mm Hg, −0.6 mm Hg, and −1.8 mm Hg, respectively). South Asian patients with poorly controlled hypertension were prescribed fewer antihypertensive medications than their black or white peers (adjusted odds ratio, 0.66; 95% confi dence interval, 0.46-0.96). CONCLUSIONS Ethnic disparities in the management of hypertension have persisted in the United Kingdom despite major investment in quality improvement initiatives, including pay for performance. These disparities are particularly marked among patients with multiple cardiovascular conditions.
Issue Brief: Racial and Ethnic Health Disparities
(2007) Meyers, Kate
Why is this Issue Relevant to Policymakers? Efforts to reduce the disturbing levels of racial and ethnic disparities in health and health care in the United States will continue to fall short unless the complex interplay of social, physical, and organizational influences is better understood and addressed through collaborative, interdisciplinary actions. What are Health Disparities? No universally accepted definition of health disparities or health inequities exists. To some, disparities are simply differences in health processes or outcomes between population groups. However, more precise descriptions focus on differences where one group is “losing” or where differences are seen as avoidable and unjust. For example, some differences between groups (such as men and women) are based on different physiology and are not “unjust,” and do not fall within the purview of health disparities. Other differences – such as average life span for racial or socioeconomic groups – are connected to issues of social advantage and are thus viewed as health disparities or inequities. In the United States, much work has focused on racial and ethnic health disparities, while many other countries focus more on socioeconomic differences.
Health Plan Effects on Patient Assessments of Medicaid Managed Care Among Racial/Ethnic Minorities
(2004) Weech-Maldonado, Robert; Elliott, Marc N; Morales, Leo S; Spritzer, Karen; Marshall, Grant N; Hays, Ron D
OBJECTIVE: To examine the extent to which racial/ethnic differences in Consumer Assessment of Health Plans Study (CAHPS) ratings and reports of Medicaid managed care can be attributed to differential treatment by the same health plans (within-plan differences) as opposed to racial/ethnic minorities being disproportionately enrolled in plans with lower quality of care (between-plan differences). DESIGN: Data are from the National CAHPS Benchmarking Database (NCBD) 3.0. Data were analyzed using linear regression models to determine the overall effects, within-plan effects, and between-plan effects of race/ethnicity and language on patient assessments of care. Standard errors were adjusted for nonresponse weights and the clustered nature of the data. PATIENTS/PARTICIPANTS: A total of 49,327 adults enrolled in Medicaid managed care plans in 14 states from 1999 to 2000. MAIN RESULTS: Non-English speakers reported worse experiences compared to those of whites, while Asian non-English speakers had the lowest scores for most reports and ratings of care. An analysis of between-plan effects showed that African Americans, Hispanic-Spanish speakers, American Indian/Whites, and White-Other language were more likely than White-English speakers to be clustered in worse plans as rated by consumers. However, the majority of the observed racial/ethnic differences in CAHPS reports and ratings of care are attributable to within-plan effects. The ratio of between to within variance of racial/ethnic effects ranged from 0.07 (provider communication) to 0.42 (health plan rating). CONCLUSIONS: The observed racial/ethnic differences in CAHPS ratings and reports of care are more a result of different experiences with care for people enrolled in the same plans than a result of racial/ethnic minorities being enrolled in plans with worse experiences. Health care organizations should engage in quality improvement activities to address the observed racial/ethnic disparities in assessments of care.

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