HPC Corner: Overcoming Health Disparities in the United States
By: John E. Jordan, MD, MPP, FACR
Health care disparities limit our country’s advance toward healthier populations and improved health outcomes. As our population becomes increasingly diverse health disparities are also likely to increase. A recent article published in the Journal of the American College of Radiology reviewed this ongoing but important threat to population health in the U.S. from the radiologist’s perspective. Health disparities exist in most domains of health care delivery, including radiology, frustrating the triple aim of value-based incentive programs. The triple aim of value-based programs: (1) improving the health care experience of patients, (2) improving the health of populations and individuals, and (3) reducing health care costs, continues to remain elusive in light of disparities. Radiologists in general and neuroradiologists in particular are becoming increasingly aware of this challenging dilemma. A number of studies in radiology have highlighted health disparities including access to and utilization of mammography and women’s imaging services, stroke care and interventions, and vertebral augmentations in the treatment of spinal fractures.
As a health policy matter, the subject of health disparities has not gone unnoticed by policy makers. Some of the major health policy initiatives designed to address healthcare disparities have included:
- Annual reports by the Agency for Healthcare Research and Quality provided to Congress regarding national healthcare disparities, mandated by the Healthcare Research and Quality Act of 1999,
- The Affordable Care Act (ACA) was enacted among other things to improve access and coverage for under- or uninsured individuals, and those vulnerable populations facing disparities in health care,
- The MACRA legislation (The Medicare Access and CHIP Reauthorization Act of 2015) was designed to develop provider incentives for rewarding quality and outcomes,
- In 2011 the Department of Health and Human Services (HHS) commissioned the Disparities Action Plan which defined strategies and priorities toward mitigating health disparities,
- and the Institute of Medicine has drawn attention to “bias, discrimination and stereotyping” that may cause a provider to treat patients differently because of a patient’s race.
Radiologists assuming greater “patient-facing” or more direct patient care roles, as well as those engaged in health policy research, education, and advocacy, are in favorable positions to work toward the mitigation of health disparities. And others in the “House of Neuroradiology” should be encouraged to join these efforts for the benefit of all patients.
- Jordan JE, Lightfoote JB. Overcoming health disparities in the United States: the value imperative for healthier populations. J Am Coll Radiol, 2018;15:479—82, 10.1016/j.jacr.2017.10.029.
- Brinjikji W, Rabinstein AA, McDonald JS, et al. Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke in US hospitals. AJNR Am J Neuroradiol 2014;35:553—56, 10.3174/ajnr.A3708.
- Gu CN, Brinjikji W, El-Sayed AM, et al. Racial and health insurance disparities of inpatient spine augmentation for osteoporotic vertebral fractures from 2005 to 2010. AJNR Am J Neuroradiol 2014;35(3):2397—402, 10.3174/ajnr.A4044.
- Gunderman RB. Addressing racial and ethnic disparities in health care. Radiology 2007;244:28—30, 10.1148/radiol.2441060305.
- Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, DC: Institute of Medicine, 2002.
- Pasick RJ, Burke NJ. A critical review of theory in breast cancer screening promotion across cultures. Annu Rev Public Health 2008;29:351—68, 10.1146/annurev.publhealth.29.020907.143420,
- Payne NR, Puumala SE. Racial disparities in ordering laboratory and radiology tests for pediatric patients in the emergency department. Pediatr Emerg Care 2013;29:598—606, 10.1097/PEC.0b013e31828e6489.