How to achieve health equity

Despite recent significant gains in health care access throughout the nation, people of color continue to grapple with a disproportionate burden of chronic disease. Two studies in the current issue of the New England Journal of Medicine (NEJM) indicate that differences in how care is delivered to patients in various racial or ethnic groups have narrowed nationally, but health outcomes remain worse for blacks than for whites.

In his editorial "How to Achieve Health Equity," also published in the just released NEJM, Marshall Chin, MD, MPH, the Richard Parrillo Family Professor of Healthcare Ethics at the University of Chicago Medicine offers additional perspective on the implications of the new findings. Chin, who is also director of the Robert Wood Johnson Foundation's Finding Answers: Disparities Research for Change program, outlines targeted strategies he says are essential to closing the health gap in America.

According to Chin, effective, sustainable efforts to achieve health equity should be guided by five key principles:

• Reporting clinical performance data that is stratified according to patients' race, ethnic group, and socioeconomic status;
• Offering interventions that are tailored for individual patients and their cultures;
• Developing health insurance payment systems that reward both high levels of quality and reductions in disparities;
• Giving additional assistance to safety-net providers, who serve greater numbers of uninsured or underinsured patients with social and economic barriers;
• Creating "risk-adjusted" clinical performance scores that level the playing field in pay-for-performance health insurance programs.

"Reducing racial and ethnic disparities in health outcomes is more difficult than simply standardizing the care provided to patients," Chin wrote in his editorial. "Indeed, although it is a positive step that improvements are being made in processes of care in hospitals, the providing of standardized care for a limited set of inpatient measures is unlikely to lead to equity in health outcomes."