Quality of Care - Medicare Should Help Reduce Disparities

Medicare Should Take A More Active Role
In Reducing Health Care Disparities

A National Academy of Social Insurance (NASI) report released December 5, 2006, Strengthening Medicare’s Role in Reducing Racial and Ethnic Health Disparities, finds that the Medicare program is in an important position to do more with its considerable purchasing clout and regulatory authority to motivate and direct health care providers to improve attention to the health care needs of racial and ethnic minorities. The chair of the study panel for the report, Bruce C. Vladeck, PhD, Interim President of the University of Medicine and Dentistry of New Jersey, and former administrator of the Centers for Medicare & Medicaid Services (CMS), notes that “Medicare has a unique opportunity to achieve reductions in disparities because of its leverage as the largest purchaser and regulator of health care.”

For racial and ethnic minority groups, health care disparities come in many forms. They include such problems as: limited access to medical professionals such as hospitals, clinics and primary care physicians; inadequate information about preventive benefits and services; lack of medical insurance; poor treatment outcomes when care is rendered; and the lack of staff with language skills and cultural sensitivities appropriate to particular racial and ethnic population(s).

While noting that health care disparities based on race and ethnicity are not new, the report makes it clear that these disparities are evident in the sources of health care available to certain racial and ethnic groups, the amount and type of care received, and in the health care outcomes obtained. The report notes that researchers have shown that “nationwide, black patients and white patients are to a large extent treated by different physicians, and the physicians treating black patients report facing greater difficulties in obtaining access to important clinical resources.” Among Medicare beneficiaries, the report notes that marked disparities persist in health care, although disparities in the use of health care services by race and income have diminished since the inception of the Medicare program.

The report concludes with the finding that Medicare is obligated to take the lead in reducing health care disparities, that as a “purchaser, Medicare provides health care to 43 million aged and disabled people, of whom one in five in non-white or Hispanic.” In addition, the report finds that Medicare is able to influence standards of health safety and quality through the “conditions of participation” that it requires of its health care providers and suppliers. These conditions, including meeting certain quality of care standards, must be met in order to obtain reimbursement for Medicare-covered services and supplies. The report notes that a focused use of this important tool would require health care providers to be more attentive to the needs of the minority populations they serve, and require them to take specific steps to reduce health care disparities.

Highlights of the recommendations of the panel include:

· Increasing Medicare’s focus on quality improvement programs that reduce disparities, including structuring incentives that reduce rather than exacerbate disparities, and insuring that beneficiaries have primary care providers.

· Insuring that minority beneficiaries are enrolled in existing programs that supplement Medicare coverage, including setting deductibles and copayments to encourage the use of services that have the potential to reduce disparities in care, and increasing access to providers.

· Increasing racial and ethnic diversity among health care providers, including increasing the number of minority providers, medical staff, and medical school faculty, and expanding curricula to include matters of cultural competency leading to a reduction in disparities.

· Holding individuals and institutional providers responsible for reducing racial and ethnic health disparities, including collecting data necessary for assessing, monitoring, and targeting disparities, strengthening the role of accrediting organizations in reducing disparities, and assuring compliance with cultural competency guidelines

· Making the reduction of health care disparities a top priority of the Medicare program, including establishing CMS performance goals for reducing disparities, enhancing the organizational structure of CMS to support the reduction of health care disparities, and addressing racial and ethnic disparities in health care as a civil rights compliance issue.

The study panel for the report, described above, was drawn from a cross-section of academics, physicians, health plan administrators, and executives of health care companies and organizations, many of whom are former officials and administrators of the Medicare agencies. Their knowledge and experience of Medicare policy, program implementation, and of the cost to the Medicare program of failing to address issues of health care disparities is compelling. We hope that the voice of this august group, through this important Report, will call our national health care policy makers to attention and action. Indeed, it provides advocates for fair access to Medicare and health care, such as those at the Center for Medicare Advocacy, with a useful advocacy tool and resource.

The report is available for free download from the NASI website, www.nasi.org. A list of the panel members is included in the report.