Approaches to Address Racial and Ethnic Disparities
GAO-03-862R: Published: Jul 8, 2003. Publicly Released: Aug 5, 2003.
A recent report by the Institute of Medicine, a branch of the National Academy of Sciences, found that racial and ethnic minority groups tend to receive a lower quality of health care than nonminorities, even when access-related factors such as income and insurance coverage are controlled. It concluded that the elimination of racial and ethnic health care disparities is a major challenge in the United States. Racial and ethnic minority groups identified by the federal government--American Indians or Alaska Natives, Asians, Blacks or African Americans, Hispanics or Latinos, and Native Hawaiians or other Pacific Islanders--are expected to make up an increasingly large portion of the U.S. population in coming years. The federal government, primarily through programs under the Department of Health and Human Services (HHS), plays a major role in providing and financing health care for minority groups. HHS is also the primary federal entity involved in projects and research aimed at understanding and addressing disparities in health care. HHS has focused on racial and ethnic disparities in health access and outcomes in six areas: cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, immunizations, and infant mortality. HHS offices and agencies, researchers at philanthropic foundations, and private organizations such as employers and health plans have efforts under way to try to address racial and ethnic disparities in health care, using interventions such as disease management programs, disease prevention programs, health literacy and language service projects, and education and outreach programs. Congress requested that we identify approaches that experts view as promising to address racial and ethnic disparities in health care.
In brief, identifying promising approaches to address racial and ethnic disparities in health care is challenging because current efforts are in early stages of implementation, evaluations and data are limited, and information on the nonfinancial causes of health care disparities is incomplete. Experts identified the following promising approaches that the federal government could pursue to address disparities: (1) develop new demonstration projects in federal programs using the best available evidence to target areas of disparities and plan promising interventions; (2) expand current efforts in programs and demonstration projects such as CDC's REACH 2010 community-based coalitions; (3) strengthen federal leadership on disparities, including prompt dissemination of information on successful interventions to reduce or eliminate health care disparities; and (4) collect complete and accurate racial and ethnic health care data in national surveys to better understand and target efforts to reduce health care disparities through steps such as ensuring the inclusion of adequate numbers of minority participants.