Various reports have documented variations in quality of care that occur among racial and ethnic populations, even after accounting for socioeconomic factors and health insurance status. Although quality improvement initiatives are often touted as the answer to healthcare disparities, researchers have questioned whether a business case exists that supports this notion. We assess various barriers and incentives for using quality improvement to address racial and ethnic healthcare disparities in small-to-medium-sized practices. We believe that although both indirect and direct cost incentives may exist, a favorable business case for small private practices cannot be made unless there are additional financial incentives. The business community can work with health plans to provide these incentives.
o r i g i n a l c o m m u n i c a t i o n Making a Business Case for Small Medical Practices to Maintain Quality while Addressing Racial Healthcare Disparities Frances J. Dunston, MD, MPH; Andrew C. Eisenberg, MD, MHA; Evelyn L. Lewis, MD, MA; John M. Montgomery, MD, MPH; Diana Ramos, MD; and Arthur Elster, MD; for the Ad-Hoc Committee of the Commission to End Health Care Disparities the need to provide preventive services, the increasing Disclaimer: The viewpoints expressed in the paper are those of prevalence of chronic disease, the aging population and the authors and do not necessarily reflect the views and poli- the corresponding time necessary for patient-centered cies of the American Medical Association or the other organi- care management add to the frustration experienced by zations of the Commission to End Health Care Disparities. many primary care physicians.2 Physicians also must Various reports have documented variations in quality of adjust their practices to accommodate a growing num- care that occur among racial and ethnic populations, even ber of racial and ethnic minority patients, and especially after accounting for socioeconomic factors and health patients with limited English proficiency. The nation’s insurance status. Although quality improvement initiatives racial and ethnic minority population now exceeds 100 are often touted as the answer to healthcare disparities, million and constitutes approximately one-third of the researchers have questioned whether a business case exists U.S. population.3 With the growing demands of primary that supports this notion. We assess various barriers and care, it is likely that the most vulnerable in our society, incentives for using quality improvement to address racial such as low-income racial and minority patients, and and ethnic healthcare disparities in small-to-medium-sized those who require additional time and care coordination, practices. We believe that although both indirect and direct will not experience improvements in quality of care not- cost incentives may exist, a favorable business case for small ed in other patients populations. private practices cannot be made unless there are addi- Numerous scientific reports over the past decade tional financial incentives. The business community can work have documented the fact that racial and ethnic minor- with health plans to provide these incentives. ity patient populations, when compared to non-Hispanic white populations, receive a lower quality of healthcare, Key words: race/ethnicity n health disparities n quality even when controlling for socioeconomic status. The improvement extent and trends of these variations are chronicled in the National Disparities Report produced annually by the © 2008. From the Department of Pediatrics, and General Pediatrics, More- Agency for Health Care Quality and Research, as well as house School of Medicine, Atlanta, GA (Dunston, A.J. McClung chair, in reports from other organizations and foundations.4,5 professor and chairperson); Iron Mountain Medical Center, Madisonville, Although financial access to healthcare is a major TX (Eisenberg); Texas A&M School of Rural Public Health (Eisenberg), Col- lege Station, TX; Department of Family Medicine and Medical and Clini- component of health disparities, racial and ethnic dif- cal Psychology, Uniformed Services University Center for Health Disparities, ferences in healthcare services persist after accounting Bethesda, MD (Lewis, deputy director); Professional Relations, BlueCross for socioeconomic and insurance status.6 Reasons for BlueShield of Florida, Jacksonville, FL (Montgomery); Department of these findings are emerging, as are solutions. Attention Obstetrics and Gynecology, Keck School of Medicine, University of South- appears to be converging on developing strategies to ern California, Los Angeles, CA (Ramos); and Division of Medicine and Public Health, American Medical Association, Writing for the Committee, improve the quality of care for all patients seen in clini- Chicago, IL (Elster, director). Send correspondence and reprint requests cal settings, with special attention given to issues rela- for J Natl Med Assoc. 2008;100:1318–1325 to: Gloria Boone, 515 N. State tively unique to racial and ethnic minority patients such St., Chicago, IL 60610; phone: (312) 464-5530; fax: (3
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