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The monthly update will also include summaries of recent journal articles and other research developments in the field as well as a featured data slide from a relevant Kaiser Family Foundation publication. 1. Indian Health Service Director Roubideaux: 'We Have A Lot To Teach The Country' DISPARITIES IN RESEARCH 7. Elderly Hispanics More Likely To Reside In Poor-Quality Nursing Homes DISPARITIES DATA SPOTLIGHT DISPARITIES IN THE NEWS 1. Indian Health Service Director Roubideaux: 'We Have A Lot To Teach The Country' In a conversation with Kaiser Health News, Dr. Yvette Roubideaux, the director of Indian Health Service—the agency that provides health care to 564 federally recognized tribes across the U.S.—says that strengthening and renewing the agency's partnership with tribes is a first priority in improving the health of American Indian and Alaska Native communities. She also wants to improve quality and access to care for the agency's patient population, and make the work of IHS "transparent and accountable and fair and inclusive." Though IHS has historically been underfunded and understaffed, and cares for a population that disproportionately suffers from diseases such as diabetes and tuberculosis, Dr. Roubideaux says that the agency has "a lot to teach the rest of the country," citing the agency's long history of diabetes programs for Indians and an electronic medical records system it has had for many years. The president's proposed 2011 budget for IHS calls for $4.4 billion—a 9 percent increase over 2010—which, if approved, would be the largest percent annual budget increase for any Health and Human Services agency (Marcy 2/12). 2. Innovative Alaska Health Plan Outperforms Many Others in Lower 48 Southcentral Foundation, a non-profit health care organization owned, managed, directed, and designed by Alaska Natives is "outperforming many better known health plans elsewhere in Alaska and in the rest of the U.S." on a number of performance and quality measures, Kaiser Health News reports. In an interview, Dr. Douglas Eby, a family physician and medical director of Southcentral Foundation, notes that while chronic disease burden is higher in the population the Foundation serves than in the general U.S. population, and despite the "historical and socioeconomic challenges" the community faces, an integrated care team, consisting of a primary-care provider, medical assistants, case managers, and others, helps them achieve measurable performance and quality improvements. He notes that over 10 years, hospital days, ER and urgent care, specialty care, and primary care visits are down, and that in 75 percent of the Healthcare Effectiveness Data and Information Set (HEDIS) measures—a tool used to measure performance on dimensions of care and service—Southcentral Foundation is at the "75th percentile or better." When asked about Southcentral's philosophy, Dr. Eby said, "[w]e are evidence-based. We believe in that. But primary care isn't manufacturing, it's not linear. It's about doctors and patients and how well they connect" (Kenen, 1/26). 3. A Remedy for Mississippi's Health Blues Dr. Aaron Shirley and a colleague are seeking $30 million in federal funds for a three-year pilot project to open Iranian-style health houses, "rural medical outposts staffed by community health workers," in 15 Mississippi Delta-region communities, the Los Angeles Times reports. Shirley and two colleagues recently flew to Iran to "study a low-cost rural healthcare delivery system that, according to the World Health Organization, has helped cut infant deaths by 70% over the last three decades." Shirley's version of Iran's health houses "calls for training nurses' aides in each community, and then sending them door to door to help with basic needs, such as taking blood pressure and improving sanitation. The health workers would refer patients to clinics or hospitals for more advanced care and follow up with home visits." Mississippi, which ranks low on most healthcare indexes, has high rates of childhood obesity, teen pregnancy, and the highest infant mortality rate in the nation. The federal government has funded healthcare research in the region, but effects have been limited. "The system is broken…It's time to try something new," said Shirley. Rep. Bennie Thompson (D-Miss), who supports Dr. Shirley's initiative, commented, "anything that can improve deplorable health conditions in the Delta, I'm going to support. Even ideas that are foreign to a lot of people" (Drogin, 1/25). 4. Using Race to Reduce Incidence of Cancer With colorectal cancer deaths 48 percent higher among African-Americans than among whites, HealthPartners Medical Group has become one of the "first medical organizations in the nation to use racial information about patients to customize their medical care," The Minneapolis Star Tribune reports. Over the past six years, HealthPartners has voluntarily collected information about race from more than 90 percent of their patients. Clinics can use electronic medical records to identify patients by characteristics like race and age, and send electronic messages that advise black patients get screened for colon-cancer starting at age 45 rather than age 50, which is recommended for other groups. HealthPartners has also used the information for breast cancer screening, and sees this information eventually being used to customize care even further (Lerner, 1/21). 5. Study: Hispanics Feel Health Discrimination The Arkansas Minority Health Commission's Arkansas Racial and Ethnic Health Disparity Study found that about half of Hispanics surveyed in the state were "without a regular health-care provider and 20 percent said they faced longer wait times and felt discriminated against while waiting to see a doctor," the Southwest Times Record reports. The study, in which 2,300 Arkansas residents, including more than 400 Hispanics, were interviewed, also found that two-thirds of Hispanics seeking medical care had difficulty understanding their doctor because they lacked an interpreter. Dr. Eduardo Ochoa, a pediatrician at the University of Arkansas for Medical Sciences, said that the data will ultimately be used to make policy recommendations on how to improve minority health care (Moritz, 1/20). 6. House Health Care Bill Offers Insurance Help To Some Migrants From Pacific Islands People from the Marshall Islands, who can travel and work freely in the U.S. but are ineligible for government programs, may soon have access to the Medicaid program through a provision in the House bill currently being debated in congress, Kaiser Health News reports. A provision in the House bill sponsored by Rep. Neil Abercrombie (D-HI) would restore Marshallese migrants' eligibility for immediate Medicaid coverage, a benefit that was revoked in 1996 as part of welfare reform. The provision would also apply to migrants from the Federated States of Micronesia and the Republic of Palau. "Rough estimates suggest there are about 20,000 islanders from the three countries living in the U.S., mostly in Hawaii. There are no estimates of how many are uninsured." Kathy Grisham, executive director of the St. Francis House in Springdale, Arkansas which sees about 1,000 Marshallese patients each year, says that the provision in the House bill "would shift the burden from the Marshallese and their inability to pay for care. It would give us a payer source for the care we're already providing." (Gold 1/5). RESEARCH 7. Elderly Hispanics More Likely To Reside In Poor-Quality Nursing Homes In a study in the journal, Health Affairs, researchers at Brown University found that, looking across nine indicators of nursing home performance, Hispanic nursing home residents were more likely than white residents to live in poor-performing facilities. Analyzing 40,762 Hispanic residents and 504,952 non-Hispanic white residents living in 5,179 nursing homes located in 136 Metropolitan Statistical Areas, the researchers found that as the percentage of Hispanic residents increased, nursing homes were more likely to be to deficiency or restraint-free, more likely to be understaffed, less likely to be financial viable, and more dependent on Medicaid funding. These findings were consistent both at the nursing home and Metropolitan Statistical Area levels. The authors note that while more resources are part of the solution, "[t]here is no straightforward resolution to this issue, and any single proposal could run the risk of putting poor minority elders at even greater risk of inadequate care or displacement, or might encounter enormous political backlash." 8. The Disproportionate Cost of Smoking for African Americans in California In a study in the American Journal of Public Health, researchers from the University of California, San Francisco estimated that the total cost of smoking for African Americans in California in 2002 was $1.4 billion. African Americans, who account for 6% of the California adult population, had a higher smoking rate than Californians in general (19.3% vs. 15.4%), and accounted for 8.2% of the total smoking-attributable health care expenditures in the state ($626 million). In addition, "[a] total of 3010 African American Californians died of smoking-attributable illness in 2002, representing a loss of over 49,000 years of life and $784 million in productivity." Combining health care expenditures and mortality, the researchers estimated that the total smoking-attributable cost for African Americans in California in 2002 was $1.4 billion, or $1.8 billion in 2008 dollars. The authors conclude that the results "confirm the need for designing tobacco control programs that can be tailored to African Americans to mitigate the disproportionate burden of smoking born by this community."
NOTES: Adjusted rates computed based on a regression model that controlled for log of income, gender, age, health status, metropolitan statistical area, region, and the highest level of education achieved by an adult family member, and included a statistically significant interaction term for race x insurance. * Statistically different from Whites at p<0.05. SOURCE: MEPS 2003-2004. Regardless of race, uninsured children were less likely to have a usual source of care or an ambulatory medical visit than children with public or private insurance coverage in 2003-2004. Despite this, racial and ethnic disparities persisted within each insurance group. Read more from the report, Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid do in Closing the Gaps? |
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Welcome to the first issue of Kaiser's Monthly Update on Health Disparities, a free, monthly report, synthesizing news coverage from hundreds of print and broadcast news sources related to health and health care issues that affect underserved and racial and ethnic communities. 
