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Health Equity Lessons from…the United States? Really?

This presentation offers health equity lessons from the United States.

Matt Kanter
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Health Equity Lessons from…the United States? Really?

  1. 1. Health Equity Lessons from…the United States? Really? Matt Kanter December 16, 2009 © The Wellesley Institute
  2. 2. Outline of Presentation • Health Equity Statistics in the U.S. • Discuss Current U.S. Health Care Reform • State and Local Equity Initiatives • Massachusetts – The City of Boston • California • New Jersey • Possible Lessons for Canada 2
  3. 3. Health Equity in the U.S. • Canadians’ perceptions of the American health care system • Medical expenditures are the leading cause of personal bankruptcies in the U.S. • What could the U.S. possibly teach Canadians about Health Equity? • First, the statistics… 3
  4. 4. Health Equity in the U.S.: The Uninsured • 17.4% of non-elderly Americans are uninsured (45.7 million people) • 32% of those considered “low-income” lack health insurance • 10.3% of children are uninsured • 20.6% of African-Americans and 32.2% of Hispanic Americans do not have insurance • 18.8% of non-elderly workers are uninsured 4
  5. 5. Health Equity in the U.S.: Health Spending 5
  6. 6. Health Equity in the U.S.: Health Spending 6
  7. 7. Health Equity in the U.S.: Health Outcomes • Life Expectancy: • U.S.: 78.1 years • Canada: 80.7 years • OECD Average: 79.0 years • The U.S. also has vast disparities in health care quality and outcomes across race, ethnicity, SES, gender, place of residence (urban vs. rural) and language (Institute of Medicine) 7
  8. 8. Current U.S. Health Care Reform Explained • (1) The Political Process: Where are We? • (2) The Basics of Reform (H.R. 3962) • (3) Forgotten (Ignored?) Health Equity Elements of the Proposed Legislation 8
  9. 9. Health Care Reform: The Process • House: Blended Bill passed November 7, 2009 (220 – 215) • Senate: Blended bill introduced on November 18, 2009; No vote yet • What’s Next? If it passes the senate, a joint House/Senate Committee will re-write the bill which must pass both houses and be signed by the President 9
  10. 10. Health Care Reform: The Basics • Individual Mandate – With Subsidies • Employer Mandate • National Health Insurance Exchange – With a Public Option? • Key Changes to Private Insurance • Paying for the Legislation/Cost Containment 10
  11. 11. Health Care Reform: Forgotten (Ignored?) Health Equity Initiatives Health Disparities Definition (in H.R. 3962): “‘Health Disparities’ includes health and health care disparities and means population specific differences in the presence of disease, health outcomes or access to care” 11
  12. 12. Health Care Reform: Forgotten (Ignored?) Health Equity Initiatives • ss. 1221 – 1223: Concerned with reducing language barriers for limited-English-proficiency populations • Sec 1442: The Secretary shall ensure that reducing health disparities is an explicit goal in her national priorities for quality improvement in health care • Sec 2251: The Secretary shall establish a cultural and linguistic competency training program for health professionals 12
  13. 13. Health Care Reform: Forgotten (Ignored?) Health Equity Initiatives • Sec 2301: The CDC shall establish a program for the delivery of community based-preventive/wellness services – At least 50% of the funds must be spent on planning/implementing wellness services whose primary purpose is to achieve a measurable reduction in one or more health disparities • Sec 2402: The Department of HHS shall establish the position of Assistant Secretary for Health Information – The Assistant Secretary shall “facilitate and coordinate identification and monitoring of health disparities…to inform program and policy efforts to reduce health disparities” 13
  14. 14. State and Local Equity Initiatives: Massachusetts Chapter 58 of the Acts of 2006 • Based on the premise of shared responsibility – Included an individual mandate with subsidies for low-income individuals, an employer mandate and a state-wide insurance exchange (called “The Connector”) • 2 years after implementation, 439,000 people had signed up for health insurance – The uninsurance rate dropped from 11% in 2005 to 2.6% 14
  15. 15. Massachusetts Continued • The MA legislation also contains several provisions which deal explicitly with reducing health disparities • Legislation creates a Health Disparities Council • It also requires a study on the possibility/cost- effectiveness of using CHWs to reduce racial/ethnic health disparities • Subsequently, MA developed an Office of Health Equity within the State Department of Health and Human Services 15
  16. 16. State and Local Equity Initiatives: The City of Boston • First U.S. city to establish a comprehensive plan to eliminate racial and ethnic health disparities (2005) • Disparities Project made 12 recommendations, including: – (1) Requiring health care organizations to gather uniform patient data on race, ethnicity, language and SES – (2) Developing skills to enable community members to become better informed and equipped patients – (3) Providing cultural competence education and training to health care professionals – (4) Increasing resources to improve workforce diversity – (5) Increasing public awareness about health disparities 16
  17. 17. Boston Continued • One year into the Project, significant results, including: – Significant progress toward building a uniform data collection system – More than 460 health care professionals completed cultural competency training – Approximately 3,000 people were directly involved in targeted community-wide education, training and advocacy; – 3,000 more received direct patient education and support – The Boston Neighborhood Network (BNN) created an 8- segment TV series about the Disparities Project 17
  18. 18. State and Local Equity Initiatives: California Health Care Language Assistance Act (SB 853) – Key Elements • Health plans must conduct a needs assessment to calculate threshold languages and collect race, ethnicity and language data • Health plans must provide quality, accessible and timely access to interpreters at all points of contact in the health care system and at no cost to the enrollee • Health plans must translate vital documents into threshold languages • Health plans must ensure that interpreters are trained, competent and that translated materials are of high quality 18
  19. 19. State and Local Equity Initiatives: New Jersey • In 2005, NJ became the first state to develop mandatory cultural competency training for physicians • SB 144 requires medical professionals to receive cultural competency training to graduate from a NJ med school or to get (or renew) a license to practice medicine • Improving cultural competence is widely recognized as integral to the reduction of health disparities 19
  20. 20. Potential Lessons for Canada • (1) Create an Office of Health Equity • (2) Need Uniform Data Collection and Analysis • (3) Recruit a Diverse Workforce • (4) Need Collaboration Among Stakeholders • (5) The Importance of Quality, Trained Health Care Interpretation • (6) Increased Cultural Competency Training 20
  21. 21. Questions and Discussion Any questions/comments? Paper available here: lth%20Equity%20Lessons%20from%20the%2 0US%20-%20Formatted%20v.3_1.pdf 21