What can America do to make health care and health outcomes more equal?

In 2003, Americans learned just how unequal health care in the United States really is.

A major report by a group of prominent experts showed wide disparities in how people of different racial and ethnic backgrounds receive treatment for a range of conditions, even if they have the same income and insurance coverage.

Of course, black people, Hispanics, Native Americans and people of other backgrounds have lived with that inequality for centuries, and researchers have documented it since the 1960s.

But the landmark reportThe bill, called “Unequal Treatment,” brought the issue to the national spotlight and prompted action on many levels. The bill helped shape the Affordable Care Act, which includes new programs like Medicaid expansion to reduce the number of people of all backgrounds who lack health insurance.

Has anything changed? Has inequality decreased?

To some extent, yes, but more action is needed. New reports“Ending Unequal Treatment” is a report first published late last month by the National Academies of Sciences, Engineering, and Medicine.

One of the authors of the new report, John Z. Ayanian, MD, MPH, heads a major institute at the University of Michigan that focuses on health care research and policy, including health equity.

Back in 2003, he was one of the researchers who conducted the research that formed the basis of the original report.

“More than 20 years later, the Commission finds that while some progress has been made, progress in eliminating health care disparities and promoting health equity has been uneven and incomplete,” he said, “and we can now see clearer links between inequities in health care and inequalities in individual and population health outcomes.”

In other words, the data clearly shows that inequalities are harming people’s health.

“We know that racial and ethnic inequities are fundamental flaws in the U.S. health care system, driven by a complex interplay of forces,” said Ayanian, a professor of internal medicine, public health and public policy at the University of Michigan and director of the University of Michigan Institute for Health Policy and Innovation.

She adds, “We also document certain approaches that have been demonstrated to improve health equity — such as community health workers who engage with people with chronic conditions, health-related social needs, or risk factors — but these approaches have not been disseminated or implemented widely enough or long enough to make a big difference.”

The committee also noted that despite the benefits that have been realized through health policy changes, other policy developments may create significant new barriers.

So what can be done? The Commission’s key recommendations are:

• Continuing the efforts begun after the first Unequal Treatment Report, we will diversify both the health care and health services research workforces to be more representative of the entire U.S. population.
• More comprehensive efforts to advance health equity, beyond the incremental and time-limited changes of the past. For example, Ayanian points out that New York City has been successful in significantly increasing colorectal cancer screening among its Asian, Black, and Hispanic residents, something that other cities and regions have yet to adopt.
• Further research and evaluation are needed to better understand inequalities and drive improvements. Ayanian and his colleagues spoke about the importance of this study during a special panel at the National Academies Health Medical Researchers Meeting in early July.
• Accountability through enforcement of existing laws and policies, such as non-discrimination under the Affordable Care Act, including by providing information in multiple languages ​​and increasing public understanding of the complaint process so that people with limited English proficiency know how to file a complaint if they feel they received unequal care.
• Create clearer and more enforceable standards through the Internal Revenue Service and the Treasury Department for nonprofit hospitals to report on the activities they are undertaking to address the health-related social needs of people in the communities they serve.
• Congressional action to ensure that affordable health insurance is available to everyone, including people who live in states that have not expanded Medicaid and immigrants, regardless of status.
• A congressional measure that would make Medicaid payments to doctors and hospitals equal to what they pay to Medicare patients for the same services. Current low payments mean only about half of doctors accept Medicaid patients, leading to health inequities as low-income people of color are more likely to qualify for Medicaid.
• Fully funds the Indian Health Service, which serves Native Americans and Alaska Natives across the country.
• Addresses disparities in Medicaid funding for U.S. territories such as Puerto Rico and American Samoa, which currently have far more limited funding and coverage than the 50 states and the District of Columbia.
• New standards for all federal departments to better collect race and ethnicity data for both health care workers and all insured and uninsured patients.
• Expanding demonstration projects aimed at addressing health-related societal needs.

In addition to the report and associated webinar, committee members outlined the following policy implications and recommendations: New Works in On the front lines of health issues.

Ayanian noted that the new report comes at a special time, as disparities have become clear during the COVID-19 pandemic.

Although deaths from COVID-19 have fallen significantly thanks to vaccinations, improved natural immunity and effective treatments, the pandemic has reversed more than a decade of progress in narrowing the gap in life expectancy between people of different racial and ethnic backgrounds.

Black and Native American life expectancies were steadily catching up with white life expectancies before 2020, and Hispanic Americans were living longer than white Americans by 2018. But from 2020 to 2021, all of this progress was reversed as COVID-19 caused significantly higher premature death rates for people of color.

The commission that produced the new report points out the huge economic impact of health care inequalities and the injustices they cause.

“Just as the first report has been used to drive these efforts over the past two decades, we hope this report will help guide effective changes in policy and practice for years to come,” Ayanian said.