Transcript Universal and Equal: Ensuring Equity in State Health Care Reform Brian D. Smedley, Ph.D. The Opportunity Agenda www.opportunityagenda.org.

Universal and Equal:
Ensuring Equity in
State Health Care Reform
Brian D. Smedley, Ph.D.
The Opportunity Agenda
www.opportunityagenda.org
State Health Care Reform
• Nearly two dozen states looking at meaningful
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health care reform, addressing coverage, cost,
quality
Using a combination of approaches
Health care reform legislation is a key
opportunity to address inequality in health care
Coverage expansions are necessary but not
sufficient to promote healthcare equity
State Health Care Equity Benchmarks –
Resources:
• IOM Unequal Treatment report, 2002
• Commonwealth Fund reports  Beal et al., Closing the Divide: How Medical Homes
Promote Equity …
 McDonough et al., A State Policy Agenda to Eliminate
Racial and Ethnic Health Disparities
 Perot and Youdelman, Racial, Ethnic, and Primary
Language Data Collection …
 Siegel et al., Enhancing Public Hospitals’ Reporting of
Data …
 D.B. Smith, Eliminating Disparities in Treatment
Ensuring Full Access to Health Care –
States Should:
• Promote medical homes
• Improve and streamline enrollment in public
insurance programs, and consistently evaluate
outreach efforts
• Promote diversity among health professionals
and cultural and linguistic competence in health
systems
Promoting Equitable Health Care Quality –
States Should:
• Require all public and private health systems to
collect data on racial/ethnic, language, and
income-based disparities in health care access
and quality
• Monitor and publicly report health care access,
quality disparities
• Ensure that disparities are a key goal of quality
improvement and pay-for-performance efforts
Patient Education and Empowerment –
States Should:
• Develop culturally-appropriate patient education and
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health literacy programs
Train, reimburse, and promote the use of community
health workers
Strengthening the Health Care
Infrastructure – States Should:
• Strengthen safety net institutions and reduce financial
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vulnerability of those serving low-income communities
Create incentives for health professionals to practice in
underserved communities
Strengthening State Program and Policy
Infrastructure – States Should:
• Strengthen Certificate of Need assessment
• Establish or strengthen state offices of minority health
Addressing Social and Community
Determinants of Health Inequality:
• Improve coordination of relevant state agencies that
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should address determinants (e.g., education, housing,
employment)
Create incentives for better food resources in
underserved communities (e.g., major grocery chains,
“farmer’s markets”)
A View from Five States
Analyzed legislation in five states (MA, WA, CA, IL, & PA)
States are addressing the benchmarks in various ways:
Access to health care
• Creating mechanisms to promote diversity among health
are professionals (MA, IL, PA)
• Improving & streamlining enrollment procedures (MA and IL)
• Evaluating outreach & enrollment procedures (MA, WA, CA,
IL, PA)
Quality of care
• Collecting data on race, ethnicity, and primary language (MA,
WA, CA, IL, PA) and publicly reporting info (MA, CA)
A View from Five States (cont.)
Patient empowerment
• Conducting a community health worker study to
determine effectiveness in reducing racial and ethnic
health disparities (MA)
Health care infrastructure
• Supporting safety net institutions such as community
health centers (MA, WA, IL)
• Providing incentives for health care professional to
practice in underserved areas (IL)
A View from Five States (cont.)
Policy infrastructure
• Utilizing community health planning to better align
resources and need (WA, IL)
• Creating a Health Disparities Council charged with
making recommendations on workforce diversity
issues, monitoring disease rates (MA)
Social and community determinants of health
• Coordinating relevant state agencies to address social
and behavioral determinants (WA)
Opportunities for Policymakers and Advocates
• Make universal health care a core goal and cover
everyone
• Assess how state policies to expand coverage affect
currently underserved groups
• Actively follow the implementation of new health care
expansion laws
• Link disparities as a core goal of the health care reform
wave