The Case for Health Equity
Health Equity: Making the Case
The Demographic Case
- More than 100 million people in the United States are considered minorities.
- Hispanics and Latinos are the largest minority group with 44.3 million or 14.8% of the population.
- African Americans are the second-largest minority group with 40.2 million or 12% of the population.
- 54 million people in the United States speak a language other than English as their primary language.
- The collective purchasing power of U.S. minorities is more than $1.3 trillion and growing.
The Business Case
- Disparities in health care lead to increased costs of care due to excessive testing, medical errors, increased length of stay and avoidable readmissions.
- Pay-for-performance contracts are beginning to include provisions to address racial and ethnic disparities. Lower patient safety and quality scores put payments at risk while improved care efficiency, effectiveness and patient satisfaction in treating culturally and linguistically diverse patients can protect or enhance value-based payments.
- Between 2003 and 2006, 30.6% of direct medical expenditures for African Americans, Asians and Hispanics were excess costs due to health care disparities.
- Eliminating care disparities would reduce direct medical expenditures by $229.4 billion.
- Eliminating health care inequities associated with illness and premature death would reduce indirect costs by $1 trillion.
The Medical Case
- Racial/ethnic minorities and Limited English Proficient (LEP) patients are more likely to experience medical errors, adverse outcomes, longer lengths of stay and avoidable readmissions.
- Language barriers can contribute to adverse events.
- Racial/ethnic minorities are less likely to receive evidence-based care for certain conditions.
- Helping patients access appropriate services in a timely fashion improves efficiency.
- Eliminating linguistic and cultural barriers can aid assessment of patients and reduce the need for unnecessary and potentially risky diagnostic tests.
- Eliminating care disparities and increasing diversity can lead to increased patient satisfaction scores.
The Legal and Regulatory Case
- Federal law (Title VI and the ADA) requires providers to provide language access services. Failure to do so can be regarded as a form of national origin discrimination. Further, violations of federal language access laws are civil rights violations which are not covered by medical malpractice insurance.
- All 50 states have language access laws.
- Research from the National Health Law Program has found that 2.5% of medical malpractice lawsuits stem from language access issues. The average cost of a typical language access case is $142,857.
- Providers must use qualified medical interpreters to obtain patients’ informed consent.
- The Joint Commission now has new disparities and cultural competence accreditation standards. Similarly, the National Quality Forum has published new cultural competence quality measures.
- The Affordable Care Act contains provisions to reduce disparities.
- Other: HIPAA, EMTALA, IRS implications