We Cannot Achieve Quality in the Absence of Equity
I strongly believe the road to quality care and the more effective use of health care dollars is firmly rooted in the elimination of racial and ethnic health care disparities. The staggering rates of health disparities in the U.S. stand as a bellwether for quality of medical care. African Americans receive poorer quality health care than whites for about two-thirds of current measures, while Hispanics receive lower quality care than non-Hispanic whites for half of quality measures. We cannot achieve quality in the absence of equity.
To achieve quality care and better use of our health care dollars, we must build a system based on improved data collection and analysis, greater public accountability, increased use of technology and a population-based system of evaluation. For far too long, we have allowed and relied upon the medical profession and our health care institutions to monitor and assess quality while hiding behind the threat of medical malpractice, the highly technical nature of medical care and the cloak of “patient confidentiality.” We have only scratched the surface of what is needed to bring about real quality improvement, reduce medical errors and eliminate health care disparities. In the absence of public policy, the financial interest of insurance companies should drive quality improvement. And, indeed, many insurance companies and even Medicare are moving to a “pay-for-performance” model. But not only are these new payment schemes limited in their effectiveness, they generate a whole new set of problems for patients and providers alike and do little to address the issue of health care disparities.
Data collection and public reporting are at a very basic level, and the interval between delivery of care and actual reporting is far too great. The current “pay-for-performance” scheme can easily lead to under-reporting, under-utilization and “creaming” of patients, leaving chronically ill patients disenfranchised. The incentives need to be aligned with: (1) accurate and timely reporting of an expanded data set including health status and demographic information; (2) improvements in health status and the management of chronic disease; (3) the development and use of technology to document, report and guide the delivery of medical treatment; and (4) reducing disparities in the quality of health care and health outcomes for racial and ethnic populations.
Payment policies should help create incentives for not only working with underserved and chronically ill patients, but support the use of evidence-based and culturally-based best practices in the treatment of illness and disease and the elimination of health care disparities. Little if any data collection and reporting are done based on race, ethnicity or income, thereby masking inequalities in care. Quality improvement efforts should drive data collection and take into account the challenges and needs of underserved communities and reward efforts that reduce disparities and improve patient outcomes. While the initial investment may be high, the improvements in patient care and safety along with the long-term financial savings in health care costs are clear.
Comments
Leave a Reply