Health Care Equity

AHA Resources

The AHA board also convened an Equity of Care committee that reports to its board of trustees.  This diverse group includes national leaders representing civil rights organizations, hospitals, public health agencies, state and federal government, academic medicine, health care researchers and others who examine and provide guidance on how hospitals can help eliminate disparities in care.

Supporting the AHA’s efforts are the Institute for Diversity in Health Management that works closely with health services organizations and educators to expand leadership opportunities for ethnic minorities in health services management.  IFD and the AHA's Center for Health Care Governance developed a trustee training program to help hospitals expand the racial and ethnic diversity of their governing boards. The AHA, the IFD and CHG have jointly created an online registry of candidates from diverse backgrounds who are interested in serving on the board of their local hospital or health system.  Also the AHA's HRET developed the Disparities Toolkit, a National Quality Forum endorsed, web-based toolkit to collect race, ethnicity and primary language data in a uniform way.

Health Care Reform and Equity

The 2010 ACA includes several provisions aimed at improving the delivery of health care services to minority populations reducing health disparities provisions. The AHA's Health Reform: Moving Forward website (AHA membership required) hosts a reform advisory that includes a comprehensive section on the provisions of the ACA that address disparities.

Key provisions include:

• Section 5307 reauthorizes and expands programs to support the development, evaluation, and dissemination of model curricula for cultural competency, prevention, and public health proficiency and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs.
  
• Section 5401 raises the funding levels for The Centers of Excellence program, which develops a minority application pool to enhance recruitment, training, and other support for minorities.
  
• Section 5402 reauthorizes and increases funding for diversity in health professions training, including scholarships for disadvantaged students who commit to work in medically underserved areas as primary care providers, and loan repayment assistance and fellowships for faculty positions.
  
• Section 5403 amends the Area Health Education Centers to expand grant authorizations to support interdisciplinary, community-based linkages that target underrepresented minorities and individuals from urban and rural medically underserved communities seeking careers in the health professions.
  
• Section 5404 expands the allowable uses of nursing diversity grants to include completion of associate degrees, bridge or degree completion programs or advanced degrees in nursing.
  
• Section 10334 elevates the Office of Minority Health (currently within the Office of Public Health and Science within the Public Health Service) to the HHS Secretary's office, to be headed by a new Deputy Assistant Secretary for Minority Health reporting directly to the HHS Secretary. It also establishes a network of new minority health offices in agencies under HHS. These offices will monitor health, health care trends, and quality of care among minority patients and evaluate the success of minority health programs and initiatives. A similar elevation will move minority health at the NIH from a Center to an Institute.
  
• Section 4302 requires that all federally funded data collection efforts on health care or public health include collection of data on race, ethnicity, primary language, sex, disability and any other indicator of disparity to better understand disparities. The HHS Secretary is required to develop standards for data collection; for race and ethnicity, the Secretary is required to use Office of Management and Budget standards. HHS also is required to collect access and treatment data for people with disabilities. Public reporting of health care quality data by race, ethnicity, primary language, gender and disability is required. Federally funded studies and surveys are required to collect sufficient data to yield statistically reliable results, and HHS is required to share health disparities data, measures and analyses with other relevant agencies.
  
• Section 4201 and Section 10403 provide Community Transformation Grants to state and local governments and community organizations for evidence-based community preventive health activities. These grants will be used to help reduce the incidence of chronic disease and develop strategies to reduce racial and ethnic disparities, including social, economic and geographic determinants of health. The law requires that at least 20 percent of the grants go to rural and frontier areas.
  
• Section 10333 provides assistance to minority populations through grant funding to community-based collaborative care networks that provide comprehensive, coordinated and integrated health care services to low-income populations. Entities eligible for grants are consortia of providers with joint governance structures, DSH hospitals and FQHCs. The funds must be used to support efforts to help low-income individuals access appropriate services, enroll in health coverage programs and obtain a regular primary care provider or medical home. Funds also can be used to provide case management and care management, perform health outreach, provide transportation, and expand capacity through such approaches as telehealth, after-hours services or urgent care, and other direct patient care services.

Business Case

Health care equity has become an important discussion nationally as policymakers aim to improve quality of care while lowering costs through a variety of changes to existing incentives.  Measurement and outcomes have become increasingly important for demonstrating the effectiveness of health care. There is a clear need to document and improve the quality of care provided to vulnerable populations. The need for data to track these disparities and develop effective programs to reduce and eliminate them is clear.
HRET advises health care organizations to collect information on patients' race and ethnicity in order to measure disparities in care-and see if they exist in the organization. Identifying and measuring disparities helps organizations initiate programs to improve quality of care. Experts assert that a growing consensus of providers accept a strategy integrating reduction in disparities in quality of care as a coherent and efficient approach to redesigning the U.S. health care system. Communities want health care providers to be accountable and responsive to them. According to the American College of Physicians 2010 position paper on racial and ethnic disparities in health care, “An ongoing dialogue with surrounding communities can help a health care organization integrate cultural beliefs and perspectives into health care practices and health promotion activities.” Tracking racial and ethnic composition with concurrently changing health care needs of communities is vital if health care providers are to fulfill their functions.