Efforts to improve health care quality limited if disparties are not a focus
Over a decade ago, health care experts declared the quality of health care in the United States is too low. In the years since, hospitals, doctors and other health care professionals have worked to improve the quality of care.
In fact, national health care reform, called the Patient Protection and Affordable Care Act (ACA), passed in 2010 has a clear focus on supporting many initiatives to improve health care quality further in the years ahead.
Even that won’t be enough, however, if quality improvement efforts don’t address known disparities in health and health care in the United States, according to physician-researchers at the University of Michigan Health System.
The act does not address major concerns about the health care system, among them pervasive and persistent disparities in health care related to factors such as sex, race, ethnicity, social class, and insurance status, according to a commentary that appears online today ahead of print in the Journal of the American Medical Association by associate professor of pediatrics, internal medicine and public policy Matthew M. Davis, M.D., M.A.P.P., and pediatrics lecturer Jennifer K. Walter, M.D., Ph.D.
“Individuals deserve health care that is not only of high quality, but of high quality for all,” says Davis, who is also co-director of the Robert Wood Johnson Foundation Clinical Scholars program at the University of Michigan in which Walter is a research fellow. “If we don’t address disparities in health and health care, we will fundamentally limit how much health care quality can improve.”
Davis and Walter provide philosophical and empiric support for their comments. They recognize that some people may be convinced by moral arguments, while others are more influenced by real-world data.
“A major advantage of philosophical arguments is that they provide a way to talk about values,” says Walter, who is an ethicist as well as a primary care doctor. “A disadvantage is that, even when people agree that disparities are unfair, they may disagree about how to address them.”
For Davis, a health policy researcher and primary care physician, the recent history of childhood vaccination efforts in the United States illustrates how effective policies can be when disparities are not only acknowledged but tackled, head-on.
“A generation ago, many disadvantaged kids died of measles in the inner cities of the U.S., essentially because our vaccination efforts were of poor quality,” Davis says. “But today, with a clear priority on measuring and fixing those disparities through lots of hard work, we now have substantially reduced disparities and improved our quality in childhood vaccination.”
“Although efforts to improve health care quality are in the sights of the ACA, disparities fall in its programmatic blind spot,” says Davis. “The highest quality health care will not be realized unless inequalities are also addressed.”
Reference: DOI: 10.1001/jama.2011.1208
Conflict of interest disclosure: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Walter reported receiving royalties from Georgetown University Press for published books on bioethics and funding from the Robert Wood Johnson Foundation Clinical Scholar Program for travel to national academic meetings. No other disclosures.
Funding/support: Dr. Davis receives support from a W.K. Kellogg Foundation grant regarding disparities in child health, education and economic opportunities. Dr. Walter is supported by Robert Wood Johnson Foundation Clinical Scholar funding.