Confronting inequality : disparities in the provision of health care among racial, ethnic and geographic populations : a special oversight hearing of the Joint Committee on Health Care

606 Pages·2002·33.8 MB·English

by  Massachusetts. General Court. Joint Committee on Health Care

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COMMITTEE BRIEFING PACKET Deposrtory Copy
Including Testimony and Material submitted Post-Hearing
Confronting Inequality:
Disparities in the Provision of H ealth Care Among
Racial, Ethnic and Geographic Populations
A Special Oversight Hearing of the Joint
Committee on Health Care
Hearing Date: June 4, 2002
Updated with Submitted Material: June 27, 2002
State House, Boston
Senator Richard T. Moore, Senate Chairman
Representative Harriett L. Stanley, House Chairman

Confronting Inequality
A Special Oversight Hearing of t he Joint Committee on Health Care
Table of Contents
I. Introduction
n. Selected Articles and Essays
1. Abstract and Executive Summary of Unequal Treatment: Confronting Racial
and Ethnic Disparities in Health Care
2. Prejudice, Clinical Uncertainty and Stereotyping as a Source of H ealth
Disparities. Ana I. Balsa, Thomas G. McGuire, July 20, 2001
3. Boston Globe article, Why Isn 't H ealth Care Colorblind? 3/26/02
4. Race/Ethnicity and Cancer Survival, the Elusive target of Biological
Differences, Catarina I. Kiefe, PhD, MD. JAMA, April 24, 2002— Vol. 287,
No. 16
5. Survival of Blacks and Whites after a Cancer Diagnosis, Peter B. Bach, MD,
et al, JAMA, April 24, 2002— Vol. 287, No. 16
6. New York Times article, Racial Gap in Cancer Survival is not Biological,
Study Finds, April 24, 2002
7. Addressing Racial and Ethnic Barriers to Effective Health Care: The Need for
Better Data. Arlene Bierman, et al. Health Affairs, Vol. 21, No. 13, May /June
2002
8. Racial Disparities in Clinical Trials, Talmadge E. King, Jr. M.D. N. Engl. J.
Med, Vol. 346, No. 1 8— May 2, 2002
IQ. List of Invited Speakers
Commissioner Howard Koh, MD, Department of Public Health
Commissioner Wendy Warring, Division of Medical Assistance
Charles A. Welch MD, Massachusetts Medical Society, President
Robert Gibbons, Massachusetts Hospital Association,
Julie Pinkham, Executive Director, MNA Massachusetts Nurses Association.
Prof. Thomas McGuire, Ph.D.
Professor of Health Economics, Harvard Medical School

Joseph R. Betancourt, MD, MPH, Senior Scientist,
Institute for Health Policy, Director for Multicultural Education,
Massachusetts General Hospital-Harvard Medical School
Giselle Thornhill, MD, MPH, Director of Clinical Health Affairs,
Mass League of Community Health Centers
John Rich, MD, Medical Director, Boston Public Health Commission
IV. Testimony and Other Material Submitted Post-Hearing
1 . Testimony of Wendy Warring, Commissioner, Department of Medical
Assistance
2. Journal Articles Submitted in conjunction with the testimony of Charles A.
Welch, MD, President, Massachusetts Medical Society
3. Testimony of Joseph R. Betancourt, MD, MPH
4. Testimony of Gisele Thornhill, MD, MPH
5. Testimony and statistical material from John A. Rich, MD, MPH and an
article from the American Journal of Public Health, Levels of R acism: A
Theoretic Framework and a Gardener 's Tale
6. The Middlesex County Alumnae Chapter of Delta Sigma Theta, submitted a
copy of a resolution adopted by the Chapter. The resolution calls for the
support of health and wellness programs for the African American
community.

Confronting Inequality
A Special Oversight Hearing of t he Joint Committee on Health Care
Introduction
In M arch of 2002 the National Academy of Science's Institute of Medicine released a
pre-publication report titled, Unequal Treatment: Confronting Racial and Ethnic Disparities
in Health Care. The report's conclusion: "racial and ethnic minorities tend to receive
lower-quality health care than whites do, even when insurance status, income, age and
severity of conditions are comparable" is, sadly, not considered surprising among health
care researchers who have examined the issue. Nor is this conclusion surprising for a
consistent reader of the Health/Science section of any of the Countries' major
newspapers or magazines; for several years now studies reporting the particulars of
disparate health care treatment have been reported by news organizations, medical
journals and other publications. Despite the attention the issue intermittently receives
however, a comprehensive public policy response involving the government, the private
health care sector and health care researchers has not been explored. It is the
Committee's hope that this oversight hearing will reveal several policy ideas — short term
and long-term — that can be pursued by all constituencies working in conceit.
The publication of Unequal Treatment is the result of a request from the U.S. Congress for
a study by the Institute of Medicine that would reveal the extent of the health disparities
and propose possible solutions. Actual publication of the full report will not occur until
the end of June 2002 but the report and the executive summary are available online at
the Institute of Medicine's website, www.iom.edu. The executive summary of Unequal
Treatment is included in this briefing packet. However, one paragraph of the executive
summary should be noted because it is a startling recitation of the extent of the problem.
On page 3 of the summary the authors' write:
A large body of published research reveals that racial and ethnic minorities
experience a lower quality of health services, and are less likely to receive even
routine medical procedures than are white Americans. Relative to whites, African
Americans - and in some cases, Hispanics - are less likely to receive appropriate
cardiac medication (e.g., Herholz et al., 1996) or to undergo coronary artery bypass
surgery (e.g., Ayanian et. Al, 1993, Hannan et al, 1999; Johnson et al, 1993;
Peterson et al., 2002), are less likely to receive hemodialysis and kidney
transplantation (e.g., Epstein et al., 2000; Barker-Cummings et al., 1995; Gaylin et
al, 1993), and are likely to receive a lower quality of basic clinical services (Ayanian
et al., 1999) such as intensive care (Williams et al., 1995), even when variations in
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such factors as insurance status, income, age, co-morbid conditions, and symptom
expression are taken into account. Significantly, these differences are associated
with greater mortality among African- American patients (Peterson et al., 1997;
Bach etal., 1999)
And research also suggests that disparate access to quality health care is not only
associated with minority status; geographic location may also be an indicator of the level
of care a patient receives. For example, a study by the Department of Public Health
found that the rate of birth defects varies by region of the state, with the western region
of the state experiencing a slightly higher rate of birth defects.
Within the literature included in this packet, the two most common suggestions for
reducing the impact of race, ethnicity and location on health care outcomes are the
increased collection of data to better target the problem and additional training of
medical students to ensure that they are able to discern any bias or harmful
preconceptions in their diagnoses or recommendations of treatment. These two
proposals, data collection and cultural competence training, should, at a minimum,
constitute the beginning of a response and it is the Committee's hope that this hearing
will reveal additional solutions as well.