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How Can Physicians Close the Disparity Gap?

Joe Cantlupe, for HealthLeaders Media, May 5, 2011

Joseph R. Betancourt, MD, MPH, recalls when he was 7 years old in the 1970s he helped his Puerto Rican grandmother interpret in English at a doctor's office in New York City.

During her session with the physician, his grandmother seemed pleased and appeared to understand the doctor's intent. Later, she observed, "I'm not sure what the doctor said and I'm not going to do it anyway,'' Betancourt recalled, evoking laughter from his audience last month at an American Hospital Association meeting in Washington D.C.

Betancourt, director of The Disparities Solutions Center and senior scientist for the Institute for Health Policy, and director of multicultural education for Massachusetts General Hospital, noted that some physicians feel if they "speak loudly enough and slowly enough" they are properly communicating to patients. More laughter.

It may be loud, he says, but it's not enough. And, ultimately, it's not funny.

Under healthcare reform, millions of currently uninsured will be become part of the insured, and many will be seeking care in physician offices instead of emergency departments.

At least 50 million Americans were without health insurance in 2009, according to the Census Bureau. About 32 % of Hispanics, 21% African-Americans, 17% Asian, and 15% whites were listed as uninsured, the bureau states.

To make healthcare reform work and more welcoming to the newly insured, it is important that the healthcare system makes significant efforts to overcome racial and ethnic disparities in care. Otherwise, how can we progress?

Yet, as healthcare reform increases reimbursements for quality, with such programs as Accountable Care Organizations, hospitals and physicians aren't moving fast enough to meet the challenges of diversity in their quality improvement programs, says Betancourt.

There are "many sources that contribute to disparities, there is no one suspect; no one solution," Betancourt said at the AHA meeting.

 "Hospitals have so many things to do. The jury has been mixed on it – do we collect race and ethnicity data? There's a lot of devil in the details. If you don't collect it, you certainly aren't going to link it to quality." As the Joint Commission pursues improvement of quality issues, Betancourt says, "you'll have early adopters and progressive (hospitals) to collect racial and ethnicity data, but others will wait until it is either forced upon them or incentivized."

Earlier this week, Betancourt and I talked more about his comments before the AHA. He says it's important that hospitals – and physicians – begin now to address disparity issues if they haven't done so already.

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