American College of Physicians: Internal Medicine — Doctors for Adults ®


ACP outlines plan to reduce racial health care disparities

From the May ACP Observer, copyright 2003 by the American College of Physicians.

By Phyllis Maguire

SAN DIEGO—As the U.S. Supreme Court in late March was debating the future of university affirmative action policies, the Board of Regents approved a new position paper that focused on reducing racial and ethnic disparities in health care that hurt minority populations and lead to poor health outcomes. The paper says that health care disparities are pervasive in this country. Minorities not only die earlier than whites, it states, but they also experience barriers to care like the lack of health care coverage and access to a personal physician.

Dr. Walker

At a press conference, Dr. Walker notes that racial disparities in health care hurt minority patients and lead to poor health outcomes.

"The issue is taking on growing national importance," said ACP Regent Charles K. Francis, FACP, past Chair of the College's Health and Public Policy Committee and president of Charles R. Drew University of Medicine and Science in Los Angeles. "It's also an integral part of the College's efforts to expand coverage to the uninsured." Dr. Francis will become President of ACP in 2004.

The new position paper identifies the following six areas where health care disparities need to be addressed:

  • Health insurance. The paper cites the lack of insurance coverage as the single biggest obstacle to obtaining quality care for minority groups. While Hispanic Americans make up only 12% of the total population, for instance, they account for almost 26% of the ranks of the uninsured.

    Because minorities are more likely to lack coverage, they tend to receive fewer preventive health services and depend on emergency room care. Latin Americans and Asian Americans who suffer from chronic diseases are also less likely to receive essential disease management and monitoring services.

    The coverage barrier has led to some grim statistics. African-Americans have a 50% higher mortality rate for heart disease than whites, as well as higher mortality rates for breast, colon, prostate and lung cancer.

    To address these problems, the paper calls on public insurance programs to streamline enrollment applications to attract more patients. The paper also says that patients who are not fluent in English should receive language assistance.

  • Cultural competency. The College calls on physicians to recognize the role that cultural differences play in patients' health. If physicians don't know that a particular patient group tends to use traditional remedies, for example, they might prescribe a medication that causes a harmful drug interaction.

    The College also calls for improved translation and interpretation services paid for by public and private insurers, not physicians.

    And while physicians often turn to patients' children to serve as interpreters, the paper warns that such action can constitute a breach of confidentiality. ACP also cautions that patients' children might withhold sensitive patient information from physicians.

  • Provider training. The paper calls for incorporating cultural competency education into all levels of physician training and professional development. Physicians as well as their staff need help in recognizing and responding to key cultural issues.

  • Health care delivery. ACP says that health care organizations need to do a better job of reaching out to members of minority communities.

    Managed care organizations can reduce disparities by providing interpreter services and patient education materials in different languages. And accrediting groups such as the Joint Commission on Accreditation of Healthcare Organizations should incorporate cultural competency standards in its accreditation procedures.

  • Workforce considerations. The paper points out that a diverse health care workforce helps eliminate disparities, citing evidence that increasing the diversity of health care professionals improves access to care for minority patients. That's because those professionals are more likely to work in minority communities where access is an issue.

    The College believes that universities and medical schools should be able to consider race and ethnicity among other factors when making admission decisions. The College also advocates for recruiting and promoting more minority faculty members and senior health care managers.

  • Research. The paper identifies research as a vital tool to monitor and address health care disparities. ACP says medicine needs clinical research that focuses on race and ethnicity to understand whether high rates of diabetes, heart disease and colon cancer among minorities are due to biological or environmental factors.

    The paper also calls on insurers and health plans to collect data on race, ethnicity and language to ascertain the scope of disparities. These measurements could help further identify instances of overutilization or underutilization of health care services by different ethnic groups.

The paper is available online.


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