In 2002, a landmark Institute of Medicine report awoke the world to shocking inequality in the health-care system. The report's conclusion: racial and ethnic minorities tend to receive lower quality of care than whites do, even after accounting for factors like income and insurance status.
The reasons for the disparity were complex and varied. The IOM pointed to differences in how minorities sought out health-care services, uncertainty amongdoctors on diagnosing and treating patients from different racial or ethnic backgrounds, and how health systems were financed and designed, among other reasons.
So how does this translate to the real world? It means if you're a white patient entering a hospital, you're more likely to get certain treatments than black and Hispanic patients are. For example, about a decade ago, 43.4 percent of white patients coming into the heart attack received an angioplasty within 90 minutes of entering the hospital, compared to just 29.2 percent for black patients and 34.1 percent for Hispanic patients.
That's one of the pretty stark findings from a recent New England Journal of Medicine study, which actually uncovers encouraging evidence that hospitals are reducing racial disparities in care. Reviewing more than 12 million hospitalizations between 2005 and 2010, researchers set out to find whether hospital quality was improving — and whether minority groups were still being left behind.
By 2010, angioplasty rates for all heart attack victims rose dramatically as the disparity gap also narrowed, according to the study. That year, 91.7 percent of white patients received the procedure within 90 minutes, compared to 86.3 percent of blacks and 89.7 of Hispanic patients — so the treatment gap between whites and blacks was cut by more than half in those five years.
The researchers found more progress than that, though. Looking across 17 quality measures for heart attacks, heart failures and pneumonia, researchers found that racial disparities were reduced in every category between 2005 and 2010. Importantly, they found hospitals were providing care more equally within hospitals, as well as between hospitals — meaning hospitals that serve higher rates of minority patients also saw improvements, the study authors wrote.
Meanwhile, another new analysis from the Urban Institute shows how the the Affordable Care Act's coverage expansion is narrowing the health insurance gap. The think tank projects that the Hispanic uninsured rate, the highest among any ethnic group, will drop from 31 percent to 19 percent by 2016, and the uninsured rate for blacks will drop from 20 percent to 11 percent.
As the above chart highlights, the coverage gains for minority groups would be even greater if every state expanded their Medicaid programs. As of Jan. 1, 27 states and Washington, D.C., will have accepted the ACA's Medicaid expansion, while three more governors are asking their legislatures to approve the program in 2015.
Most significantly, the NEJM and Urban studies indicate that our health care system is getting more fair.