Frontiers of Health Services Management - Spring 2014 - (Page 19)

In short, improving quality, addressing disparities, and achieving equity are no longer just the right things to do-they also are the smart things to do, given the new set of financial structures developed to drive quality and value. What Are the Root Causes of Disparities? * Health system factors: the complexity of the healthcare system, the difficulty minority patients may encounter Health System Factors: Challenges in Navigating the Healthcare System Several seminal reports demonstrate that multiple barriers prevent immigrants, patients with limited English proficiency or low health literacy, and minorities from receiving timely, effective care, leading to disparities. For instance, patients may not be familiar with the use of primary care services, relying instead on urgent care or emergency services (Collins et al. 2002). They may not understand how to prepare for a procedure, access specialty care, or follow up on an abnormal test result (Scheppers et al. 2006). Provider Factors: Barriers to Communication and Rapport Several studies show that providers communicate less effectively with minority patients and those with language barriers and are less likely to build trusting relationships with minority patients than with white patients (e.g., Gordon et al. 2006). For example, a national survey found that Hispanics were twice as likely as whites to report one or more communication problems, such as not understanding their doctor, feeling their doctor did not listen to them, or being afraid to ask questions; a third of Hispanics and a quarter of African Americans and Asian Americans have experienced these communication problems (Collins et al. 2002). Jos e p h R . B e ta nc ourt * 19 F E A T U R E There is little doubt that certain social determinants-low education levels, low socioeconomic status, inadequate and unsafe housing, racism, and living in proximity to environmental hazards, for example- disproportionately affect minority populations and contribute to their poor health outcomes (Andrulis 1998; Antonovsky 1968; Flores et al. 2002; Hinkle et al. 1968; Pincus and Callahan 1995; Pincus et al. 1998; Williams 1990). Similarly, lack of access to care-a particular problem for minority populations-takes a significant toll, as uninsured individuals are less likely than those with health insurance to have a regular source of care, are more likely to delay seeking care (Giacovelli et al. 2008; Stevens, Seid, and Halfon 2006), and are less likely to receive needed care (Hargraves 2002). Lack of access ultimately results in avoidable hospitalizations, inappropriate utilization of the emergency department, and adverse health outcomes for minorities in the United States (Byrd 1990; Williams et al. 1997). Unequal Treatment argues that racial and ethnic disparities in care quality contribute to disparities in health outcomes. The root causes of such disparities are complex; Unequal Treatment groups them according to the following factors (Smedley, Stith, and Nelson 2003): navigating it, and the lack of interpreter services to assist patients who have limited English proficiency * Provider factors: providers' stereotyping of patients, the impact of race and ethnicity on clinical decision making, and clinical uncertainty due to poor communication * Patient factors: patient mistrust, refusal of services, poor adherence to treatment, and delays in seeking care

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Spring 2014

Frontiers of Health Services Management - Spring 2014
Contents
Editorial
Baylor Health Care System’s Journey to Provide Equitable Care
In Pursuit of High-Value Healthcare: The Case for Improving Quality and Acheiving Equity in a Time of Healthcare Transformation
Ending Healthcare Disparities: An Urgent Priority and a Growing Possibility
Expanding the Evidence Base for Health Equity
A Historical Perspective on Disparities as Context for Our Work Ahead

Frontiers of Health Services Management - Spring 2014