Economic, Racial Health Care Disparities Persist Despite ACA

Researchers suggest financial incentives to reward patient-centered care.

Despite ongoing efforts to close the health care gap among low income individuals, racial and socioeconomic disparities persist, according to a recent study.

Published in the journal BMJ, researchers evaluated preventable hospital admissions in light of the complexities of reaching health care equity. The study notes that income disparities continue even with near universal health coverage access.

An editorial by Marshall Chin, MD, MPH, found that while the Affordable Care Act is a significant step toward closing health care gaps, it may not be enough. Dr. Chin said a number of interventions need to be implemented with health care reform to achieve health equity.

Dr. Chin suggests lawmakers create financial incentives to reward patient-centered care, excellent communication, and shared decision making with patients; reward high levels of quality and reductions in disparities; and provide additional support to organizations that provide health care to vulnerable populations.

Following the implementation of health care reforms in Massachusetts nearly a decade ago, researchers examined the association between access to health insurance and disparities in health status. The analysis confirmed a positive impact from expanded coverage and reduced financial barriers among low income populations.

However, an intensive examination of care delivery for common conditions showed that many patients still face significant obstacles to care.

A study of the differences in the rates of knee and hip replacement surgery revealed that greater access to health insurance correlated with the increased use of the procedures among Hispanics and blacks, yet the same results were not found for low-income patients compared with higher income individuals.

Another study found no relationship between health care reforms in Massachusetts and decreased racial and ethnic disparities in hospital admissions for conditions such as asthma, diabetes, and heart failure.

The reasons for the ongoing disparities remain unclear, the researchers noted.

While questions remain regarding the ability of the ACA to generate real improvements in health care outcomes for minority and low-income populations, Dr. Chin concluded that the legislation represents an opportunity to evaluate the next steps to achieve health equity.

"These 2 studies confirm that extra insurance coverage and generic efforts to improve the quality of care are helpful but will not eliminate differences in outcomes," Dr. Chin said. "Clinicians must identify and overcome the many health barriers faced by disadvantaged populations, including mistrust of the health care system and previous negative health care experiences."