Strengthening Medicare's Role in Reducing Racial and Ethnic Health Disparities

Publication Date:

Publisher: National Academy of Social Insurance

Author(s): National Academy of Social Insurance

Research Area: Health

Type: Report

Abstract:

Disparities in health care for racial and ethnic minorities and low income persons pose a pressing national problem. This report of a study panel convened by the National Academy of Social Insurance examines Medicare's role in moving towards a solution. The panel concludes that Medicare is obligated to take the lead in reducing disparities—both for its beneficiaries and throughout the health system—and makes 17 recommendations to those who set policy for and administer the Medicare program.



Disparities are evident in the sources of health care, in the amount and type of care received, and in health outcomes. Nationwide, black patients and white patients are to a large extent treated by different physicians, and the physicians treating black patients report facing greater difficulties in obtaining access to important clinical resources (Bach et al. 2004). Even among Medicare beneficiaries, marked disparities persist in health care, although disparities in the use of health care services by race and income have diminished since Medicare's implementation. Minorities also fall short of whites on many measures of health status.



Medicare cannot immediately close a gap in health status caused by a lifetime of disparate care. Because of its dominant influence over the entire health care sector, Medicare has unique opportunities to, and responsibility for, reducing racial and ethnic health disparities. Along with its ability to improve the care provided to its 9 million minority beneficiaries, Medicare's leverage as the largest purchaser and regulator of health care provides an ability to achieve reductions in disparities. As a social insurance program, Medicare has the responsibility to ensure that all those who have contributed to the program receive appropriate care on a fair and nondiscriminatory basis.



The panel's recommendations fall into five categories:



1. Improving the quality of clinical care
2. Increasing access to care
3. Educating health professionals to improve diversity and cultural competence
4. Holding health care providers responsible for reducing disparities
5. Making the reduction of disparities a top administrative priority and focus.



In each of these areas, Medicare has tools that it can use to help reduce disparities. The summary table lists the recommendations, and the panel's report details both the ecommendations and their rationale. Some of the recommendations would require legislation, but most could be implemented by the Centers for Medicare & Medicaid Services and the Department of Health and Human Services within their current statutory authority. Most of the recommendations would require additional Medicare spending—especially for program administration—and the panel urges the Congress to appropriate the necessary funds.