February 1, 2010
R. T. Konetzka and R. M. Werner, “Disparities in Long-Term Care: Building Equity into Market-Based Reforms,” Medical Care Research and Review, Oct. 2009 66(5):491–521.
Market-based policies intended to improve long-term care, such as public reporting of health care quality and pay-for-performance initiatives, could have unintended consequences. Rather than “lifting all boats,” such programs may exacerbate disparities in the quality of long-term care, according to a Commonwealth Fund–supported study published in Medical Care Research and Review.
Consumers from different racial, ethnic, and socioeconomic groups may not have equal access to information on quality, and care providers serving disadvantaged or minority patients may not have the resources needed to respond to quality incentives. To promote equity and improve quality, the authors suggest “demand-side” policies that would encourage minority and poor consumers to choose high-quality long-term care facilities, such as educational campaigns held in conjunction with public reporting initiatives. They also suggest “supply-side” policies, such as basing pay-for-performance on incremental improvement rather than solely on absolute levels of quality.