Healthcare Disparities at the Crossroads with Healthcare Reform

Abstract

This chapter discusses the role of quality improvement (QI) as a vehicle for eliminating racial and ethnic disparities in health care. Disparities in health and disparities health care are not synonymous. The latter represents only one of many contributors to disparities in health. Furthermore, healthcare disparities result from a complex constellation of patient, provider, organizational, and community/ societal factors. Tackling inequities in health care requires addressing the predominant cause for a particular healthcare disparity. This can be done through well-designed quality improvement interventions. Such interventions can potentially reduce healthcare disparities through either targeted or universally applied strategies. The former specifically targets minority patients within a healthcare organization or targets organizations that serve largely minority patients. The latter applies quality improvement activities to all patients in the expectation that the intervention disproportionately benefits minorities. A range of quality improvement tools exist to improve care to minorities. Review of available evidence shows that it is possible to reduce, if not eliminate, disparities in health care using these tools. However, doing so requires a concerted commitment on the part of health plans and insurance payers to adequately fund such efforts. Health reform legislation and better tracking of healthcare disparities may spur progress towards the elimination of healthcare disparities.