Published on Friday, September 18, 2009 by The Baltimore Sun

Cost of Racial Disparities in Health Care Put at $229 Billion Between 2003, 2006

by Kelly Brewington

Racial health disparities cost the United States $229 billion between 2003 and 2006 - money that could help cover an overhaul of the nation's health care system, according to a new report by Johns Hopkins and University of Maryland researchers.

Minorities are generally sicker and more likely than whites to die of numerous diseases, and until now, medical experts and advocates fighting to close those gaps have made their pleas on moral grounds. But the new figures aim to break down the issue into dollars and cents at a time when everyone is trying to figure out how to rein in soaring health care costs.

"The statistics are just stunning and shocking," said Health and Human Services Secretary Kathleen Sebelius, during an announcement of the findings Thursday. "There is no question that reducing the health disparities can save incredible amounts of money. But more importantly, it saves lives and it makes us a healthier and more prosperous nation."

If the country is serious about reforming health care, policymakers need to find ways to erase these inequalities, said Thomas A. LaVeist, director of the Hopkins Center for Health Disparities Solutions and an author of the report.

LaVeist gleaned the figures from data from the government's Medical Expenditure Panel Survey, which keeps tabs on how much individuals pay for health care and how healthy they are. He broke down the figures by race and age group to determine how minorities fare compared with whites in different categories.

But others said the study overstates the potential savings. While eliminating health disparities among minorities could certainly save money, figuring out how to do that is the tough part, said Jay Wolvovsky, president and CEO of Baltimore Medical System, whose seven health care centers treat 47,000 people in Baltimore city and county - 74 percent of whom are minorities.

"Calculating the savings does not easily translate into realizing those savings," he said. "To expect that health care reform will provide savings at the full level that is expressed in this study over any short-term basis may be very optimistic."

It's long been known that rates of disease are worse for minorities than for whites. It'sless clear how to fix these gaps. Vietnamese-American women have nearly five times the rate of cervical cancer as white women.

Black men are twice as likely to have prostate canceraswhite men. And Mexican-Americans are nearly twice as likely to have diabetes as whites.

There are disparities in access to care, too, and minorities are typically less likely to have health insurance than whites. But other studies show that racial and ethnic minorities are less likely to get quality care they need even when they have coverage, said Brian Smedley, director of the health policy institute at the Joint Center for Political and Economic Studies, a think tank on racial issues which took part in the report's release.

The issue is complex and the cause of the disparities is not completely known. Most researchers say factors such as unequal access to health care, poverty, and even genetics all play a role. While the study puts a dollar figure on how these discrepancies result in higher medical costs, the researchers do not offer specific examples of how to fix these gaps beyond the concept of a health care overhaul.

LaVeist thinks this report is a starting point for more of those conversations. And most importantly, he hopes it gives ammunition to advocates who want to reform the current health care system.

"People are dying needlessly in a country that is rich enough to do something about it," he said.

The health care reform proposals should go farther to help fix the problem, said LaVeist. While legislation focuses on expanding health insurance to some 47 million Americans and decreasing health care costs, it says little about health disparities or improving the quality of care, LaVeist said. He says there are broader societal factors that make the cost of disparities even larger - such as lost work days and the human toll of premature deaths.

Others argue that there are limits to what the reform proposals can do. While expanding primary care access, improving quality standards and using electronic medical records could mean better care for everyone - including minorities - the disparities also stem from many other factors that have little to do with the health care system, Wolvovsky said.

Environmental factors like poverty, lack of access to housing and transportation, and disparities in education and even cultural beliefs all play a role in health disparities and are not the subject of any legislative proposals. But how does a health care bill address those intractable problems?

"These factors are not quite so easily leveled as those related to the reform of the health care system itself," said Wolvovsky.

The major reform proposals offer some ideas for narrowing the racial gaps, such as incentives for physicians to work in underserved areas, said Dennis P. Andrulis, director of the Center for Health Equality at Drexel University, in a separate study whose findings were also shared Thursday.

But the proposals should do more, such as providing more money to safety net hospitals that tend to treat low-income minorities and the uninsured, as well as grants to providers and hospitals that specifically aim to narrow the racial gaps, he said.

Health disparities

A report by Johns Hopkins Bloomberg School of Public Health and University of Maryland researchers estimates that racial health disparities cost the U.S. $229 billion between 2003 and 2006. Here are some of those disparities:

• Mexican-Americans are nearly twice as likely to have diabetes as whites.
• Vietnamese-American women have nearly five times the rate of cervical cancer as white women.
• Black men are twice as likely to have prostate cancer as white men.