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AHRQ: Measures of Disparities in Access to Care Show Declines or No Gain

By John Reichard, CQ HealthBeat Editor

April 20, 2012 -- The nation is either making no progress or is heading in the wrong direction in reducing racial, ethnic, and income-related disparities in access to care, the Agency for Healthcare Research and Quality (AHRQ) said in a recently released report.

A second report released at the same time, the agency's annual snapshot of the quality of care in the United States, found slow improvement on quality performance measures between 2002 and 2008.

Fifty percent of the measures that tracked disparities in access to care showed no improvement, and another 40 percent showed gaps widening between 2002 and 2008, the disparities report said.

AHRQ Director Carolyn M. Clancy suggested in a news release that the health care law, which extends coverage to some 30 million uninsured Americans, would reverse the trend. "The health care law's groundbreaking policies will reduce health disparities identified in the report and help achieve health equity," Clancy said. Of course, the law (PL 111-148, PL 111-152) is under review by the U.S. Supreme Court and may be modified or repealed by that body. If it does pass muster with the court, it could be canceled next year if Republicans make big gains in the fall elections.

Hispanics, American Indians and Alaska Natives experienced worse access to care than whites on more than 60 percent of access measures. Blacks experienced worse access on slightly more than 30 percent of the measures. Asian-Americans experienced worse access than non-Latino whites on 17 percent of the measures.

Examples of access measures included the percentage of a particular group who are uninsured all year and the percentage reporting delaying or skipping needed dental or medical treatment for financial reasons. Taking the two reports together, the data show that health care quality and access are "suboptimal," AHRQ said, "especially for minority and low-income groups."

"Urgent attention is warranted to ensure continued improvements in quality and progress on reducing disparities with respect to certain services, geographic areas and populations," including diabetes care, disparities in cancer screening and access to care, and states in the South, the agency said.

Only one disparity in access to care contracted: the gap between whites and Asian-Americans.

The disparities report also examined diversity in the health care workforce. For almost all occupations, whites and Asian-Americans were "overrepresented" while blacks and Hispanics were underrepresented.

However, the report noted, "blacks are overrepresented among licensed practical and licensed vocational nurses while Hispanics are overrepresented among dental assistants." The report noted that of the health care occupations tracked, "these two required the least amount of education and have the lowest median annual wages."

The quality of care report card showed that people on average received preventive services tracked by the researchers 60 percent of time, appropriate acute care services 80 percent of the time and recommended chronic disease management services 70 percent of the time. Of the performance measures relating to acute care, 77 percent showed improvement. That was the case for only about half of quality measures relating to preventive care and management of chronic diseases.

In addition to access differences, "disparities in quality of care are common," the report noted. Thus, adults age 65 and over received worse care than adults of age 18 to 44 for 39 percent of quality performance measures. Blacks received worse care than whites for 41 percent of quality measures. "Poor people received worse care than high-income people for 47 percent of measures," the report noted.

While minorities generally fared worse in access to care and quality of treatment, that's not always the case. Racial and ethnic minorities often experienced better cardiovascular care than whites, said William Freeman, one of the authors of the two reports. He said, for example, that a higher percentage of blacks than whites reported receiving blood cholesterol screenings in the past five years.

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