Health inequities haven't improved in last two decades, report says
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More than 20 years after a landmark report chronicled the existence and drivers of health inequities in the U.S., a sequel published Wednesday finds little has improved.
Why it matters: Despite greater awareness, inequities are baked into the U.S. health care system and will take intentional policy change and structural redesign to dislodge, the National Academies of Sciences, Engineering, and Medicine concluded.
The big picture: While major changes to the health care system over the past two decades, including the Affordable Care Act, have improved care for people of color, other changes have slowed down progress, the report said. Important components of the ACA have also been blocked from implementation, it noted.
- "The United States likes to see itself as the world's standard bearer of excellence in health care. Yet when compared to other industrialized nations, we are not the exemplars we believe we are," wrote the co-chairs of the committee that created the report.
Between the lines: Key levers for driving and mitigating inequities include health care laws and payment policies, the delivery of care, and data and research, according to the report.
- It offers a series of recommendations for how to use these levers to reduce disparities.
The intrigue: The report specifically calls out the U.S. insurance system for its lack of universal coverage and the wide differences in how Medicare, Medicaid and commercial insurance pay for care.
- "These structural inequities result in unequal access to health care services. This means that the system is inherently separate and unequal," the authors write.
- Although coverage-related inequities primarily impact the populations disadvantaged by them, the effects can be felt systemwide, they argue.
- That's because "they threaten the fiscal viability of the entire system, lead to the loss of years of avoidable productive life and of economic productivity, and decrease health care affordability for everyone."
- Among other recommendations, it suggests Congress should create a pathway for Medicaid payment policies to be on par with Medicare.
Yes, but: The National Academies said its original 2003 report had some positive impact by spurring research into the root causes of inequities and broader awareness among the public and health providers.
The bottom line: As the report repeatedly emphasizes, health inequities affect everyone — and solving them benefits everyone.
- That's partly because they're a drag on the economy, and partly because eliminating disparities could also lead to better health care more broadly.
