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Congress Faces Several Hurdles in Correcting Health Care Disparities

By Whitney Blair Wyckoff, CQ Staff

June 11, 2008 -- Providing health care coverage to all Americans may help reduce health care disparities but even with universal coverage, inequities may remain, lawmakers said Tuesday.

"Universal coverage won't be able to end the disparities, but you won't be able to end the disparities without it," said Ways and Means Health Subcommittee Chairman Pete Stark, D-Calif., after a subcommittee hearing on how health overhaul legislation could address health care disparities.

Statistically, women and racial and ethnic minorities receive poorer access to care, poorer quality of care, and have poorer health outcomes. Studies also have shown that there is a higher prevalence of certain diseases among some populations. A host of socioeconomic factors such as place of residence, income, education, and insurance status also contribute to health care disparities, according to the subcommittee.

Panel members and witnesses said that even with health care coverage, disparities exist for several reasons, including income, education, environment, and geography. People who live in rural areas also face higher levels of disparities in care, said Rep. Dave Camp of Michigan, the panel's ranking Republican.

Language barriers also contribute to the problem, medical experts told the panel.

When working with limited English proficiency patients, "three-quarters of physicians use family members as interpreters and less than half of physicians use trained interpreters," said physician Michael A. Rodriguez of the University of California-Los Angeles Department of Family Medicine. Rodriguez said that interpreters can be costly, inconvenient and not readily available.

"There is a need to develop programs and policies to promote the provision of adequate language services to the rapidly growing population" of limited-English speaking families, Rodriguez said.

Another witness, Marsha Lillie-Blanton of the Kaiser Family Foundation, said that of the 47 million non-elderly Americans who were uninsured in 2006, about half were minorities. She said insurance could be a stepping-stone to addressing disparities, however she called for more research to be done so that the issue could be addressed.

Witnesses said to get a true picture of the task at hand, there needs to be more comprehensive data on health care access.

"To improve quality, you need good policy informed by good research and data," Rodriguez said. Without the data, he said it is difficult to target the issue.

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