By: Hugh B. Price
President
National Urban League
As a whole, Americans enjoy an unparalleled system of high-quality health care. The advances that were made in the latter half of the twentieth century in spreading both knowledge about and access to health care-whether one gets it in large institutional hospitals or from the local general practitioner-probably rank as one of America's greatest accomplishments as a nation.
Yet, it's become more and more evident that significant inequality continues to exist when it comes to who can take advantage of America's health care system.
In fact, problems continue not only in expanding access to quality health care but also in maintaining the level of access that's been achieved.
That sobering reality has been underscored this month by three new pieces of information-two formal studies and one newspaper article-about access to health care in America.
One was the massive study researchers from the Harvard University School of Public Health published in the March 13 Journal of the American Medical Association exploring differences in access to and quality of health care among white and African-American Medicare patients.
Medicare is the government-funded managed-care health system for people over 65.
The study of 305,000 cases scrutinized the treatment patients received in four areas. One involved eye examinations for progressive vision destruction caused by diabetes. The others were: whether patients received state-of-the-art medication after a heart attack; whether they were hospitalized for mental illness; and whether female patients were screened for breast cancer.
In all of these areas, the study found, the quality of care blacks received lagged behind that of whites.
The most significant gap, according to the researchers, was that of treatment for psychiatric disorders: only 33 percent of blacks diagnosed with mental illness were hospitalized compared with 54 percent of whites.
Although written in the dry, dispassionate language academic medicine requires, the point of their findings cannot be missed:
"The technology of medical care has improved dramatically in the past century," the study declares, "yet for some populations in the United States, care has fallen short of important goals. In particular, blacks have been less likely to receive many types of medical services and procedures. "
It goes on to make an even broader point. "Blacks bear a disproportionate share of suffering related to a variety of chronic diseases. To the extent they fail to receive quality care, they may be at risk for complications that could otherwise have been ameliorated or prevented altogether."
This latter declaration is also a strong theme undergirding a study released this month by the Commonwealth Fund, which looked more broadly at health care issues and found that Asian and Hispanic Americans as well as African Americans lag behind whites in nearly every measure of the quality of health care.
One of the study's bedrock findings, which also showed up in the Harvard study, was that large numbers of members of all three groups-nearly one-third of Hispanic Americans, and one-quarter of African and Asian Americans, say they have significant difficulty communicating with their physicians. They say some of this is due to language and cultural barriers. But many also feel their physicians do not treat them with respect.
One result of this, the Commonwealth Fund study determined, was that more than 40 percent of both Hispanic and Asian Americans say they don't have a great deal of confidence and trust in their doctor. By contrast, about 30 percent of both blacks and whites say they lack confidence in their physician.
Obviously, both studies offer richer and more complex insights than a brief summary can indicate; and these findings add more necessary data to that of previous studies and to the already numerous programs which have shown that efforts to expand the quality of and access to health care can succeed.
For example, as the Harvard study pointed out, one seemingly obvious, simple measure is ensuring that a primary care physician is involved with a patient's case.
But the fact that this solution is not so "simple" after all was underscored by a recent New York Times article showing that more and more doctors are avoiding taking on new Medicare patients because they say the government pays them too little to cover their costs. The federal Medicaid payment to doctors was cut by more than 5 percent this year.
Many doctors in private practice have long refused to take patients in the Medicaid program, which provides health care for poor people, because they contended that program pays so little they can't cover their costs.
Thus, just as the inequality remaining in Americans' access to health care is becoming more and more evident, the two major federal programs intended to achieve that goal are caught in an economic squeeze.
But the most important point to understand is that just as there's no one "big" cause of this problem, there's no one silver bullet that will eliminate it. All parties-government, the medical community, and civic groups among Americans of color, too-must do their part to help find a cure for the inequality bedeviling the health-care system in America.
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