Health Care
Approaches to Address Racial and Ethnic Disparities
Gao ID: GAO-03-862R July 8, 2003
A recent report by the Institute of Medicine, a branch of the National Academy of Sciences, found that racial and ethnic minority groups tend to receive a lower quality of health care than nonminorities, even when access-related factors such as income and insurance coverage are controlled. It concluded that the elimination of racial and ethnic health care disparities is a major challenge in the United States. Racial and ethnic minority groups identified by the federal government--American Indians or Alaska Natives, Asians, Blacks or African Americans, Hispanics or Latinos, and Native Hawaiians or other Pacific Islanders--are expected to make up an increasingly large portion of the U.S. population in coming years. The federal government, primarily through programs under the Department of Health and Human Services (HHS), plays a major role in providing and financing health care for minority groups. HHS is also the primary federal entity involved in projects and research aimed at understanding and addressing disparities in health care. HHS has focused on racial and ethnic disparities in health access and outcomes in six areas: cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, immunizations, and infant mortality. HHS offices and agencies, researchers at philanthropic foundations, and private organizations such as employers and health plans have efforts under way to try to address racial and ethnic disparities in health care, using interventions such as disease management programs, disease prevention programs, health literacy and language service projects, and education and outreach programs. Congress requested that we identify approaches that experts view as promising to address racial and ethnic disparities in health care.
In brief, identifying promising approaches to address racial and ethnic disparities in health care is challenging because current efforts are in early stages of implementation, evaluations and data are limited, and information on the nonfinancial causes of health care disparities is incomplete. Experts identified the following promising approaches that the federal government could pursue to address disparities: (1) develop new demonstration projects in federal programs using the best available evidence to target areas of disparities and plan promising interventions; (2) expand current efforts in programs and demonstration projects such as CDC's REACH 2010 community-based coalitions; (3) strengthen federal leadership on disparities, including prompt dissemination of information on successful interventions to reduce or eliminate health care disparities; and (4) collect complete and accurate racial and ethnic health care data in national surveys to better understand and target efforts to reduce health care disparities through steps such as ensuring the inclusion of adequate numbers of minority participants.
GAO-03-862R, Health Care: Approaches to Address Racial and Ethnic Disparities
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July 8, 2003:
The Honorable Bill Frist:
Majority Leader:
United States Senate:
Subject: Health Care: Approaches to Address Racial and Ethnic
Disparities:
Dear Senator Frist:
A recent report by the Institute of Medicine, a branch of the National
Academy of Sciences, found that racial and ethnic minority groups tend
to receive a lower quality of health care than nonminorities, even when
access-related factors such as income and insurance coverage are
controlled.[Footnote 1] It concluded that the elimination of racial and
ethnic health care disparities is a major challenge in the United
States. Racial and ethnic minority groups identified by the federal
government--American Indians or Alaska Natives, Asians, Blacks or
African Americans, Hispanics or Latinos, and Native Hawaiians or other
Pacific Islanders--are expected to make up an increasingly large
portion of the U.S. population in coming years.
The federal government, primarily through programs under the Department
of Health and Human Services (HHS), plays a major role in providing and
financing health care for minority groups. HHS is also the primary
federal entity involved in projects and research aimed at understanding
and addressing disparities in health care. HHS has focused on racial
and ethnic disparities in health access and outcomes in six areas:
cancer screening and management, cardiovascular disease, diabetes, HIV
infection/AIDS, immunizations, and infant mortality. HHS offices and
agencies, researchers at philanthropic foundations, and private
organizations such as employers and health plans have efforts under way
to try to address racial and ethnic disparities in health care, using
interventions such as disease management programs, disease prevention
programs, health literacy and language service projects, and education
and outreach programs. You requested that we identify approaches that
experts view as promising to address racial and ethnic disparities in
health care. The enclosure contains the information we provided during
our July 8, 2003, briefing of your staff.
To respond to your request, we reviewed studies, journal articles,
reports, and evaluations by the Institute of Medicine, federal
agencies, researchers, and other organizations on racial and ethnic
health care disparities and on potential:
interventions to reduce disparities. We also interviewed federal
officials at the Office of Personnel Management, HHS's Office of
Minority Health, and six HHS agencies--the Agency for Healthcare
Research and Quality (AHRQ), Centers for Disease Control and Prevention
(CDC), Centers for Medicare & Medicaid Services (CMS), Health Resources
and Services Administration (HRSA), Indian Health Service (IHS), and
National Institutes of Health (NIH)--to learn about their programs and
initiatives. In addition, we obtained information on relevant programs,
initiatives, and promising approaches to address disparities from
health care researchers at academic institutions and research
organizations such as the Institute of Medicine, representatives from
large employers and a health plan, and officials at philanthropic
foundations and other organizations. We performed our work from April
through June 2003 in accordance with generally accepted government
auditing standards.
In brief, identifying promising approaches to address racial and ethnic
disparities in health care is challenging because current efforts are
in early stages of implementation, evaluations and data are limited,
and information on the nonfinancial causes of health care disparities
is incomplete. Experts identified the following promising approaches
that the federal government could pursue to address disparities:
* Develop new demonstration projects in federal programs using the best
available evidence to target areas of disparities and plan promising
interventions.
* Expand current efforts in programs and demonstration projects such as
CDC's REACH 2010 community-based coalitions.
* Strengthen federal leadership on disparities, including prompt
dissemination of information on successful interventions to reduce or
eliminate health care disparities.
* Collect complete and accurate racial and ethnic health care data in
national surveys to better understand and target efforts to reduce
health care disparities through steps such as ensuring the inclusion of
adequate numbers of minority participants.
We provided a draft of this report to officials at HHS for their
technical review. We incorporated their comments as appropriate.
As we agreed with your office, unless you publicly announce the
contents of this report earlier, we plan no further distribution of it
until 30 days from the date of this letter. We will then send copies to
the Secretary of HHS, the Director of the Office of Personnel
Management, and interested congressional committees and will make
copies available to others upon request. The report will also be
available at no charge on the GAO Web site at http://www.gao.gov.
If you have any questions or need additional information, please
contact me at (202) 512-7119 or Kim Yamane at (206) 287-4772. Lisa A.
Lusk and Elaine Swift made key contributions to this report.
Sincerely yours,
Janet Heinrich:
Director, Health Care--Public Health Issues:
Signed by Janet Heinrich:
Enclosure:
[See PDF for image]
[End of figure]
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FOOTNOTES
[1] Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, eds.,
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health
Care (Washington, D.C.: National Academies Press, 2003).