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

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by
The Baltimore Sun

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

by
Kelly Brewington

Ernest Sass, 52, (L) winces as he is attended to by Girish Bobby Kapur, M.D. (R) in a room used to see patients who don't require treatment for trauma inside the emergency room at Ben Taub General Hospital in Houston, Texas July 27, 2009. (REUTERS/Jessica Rinaldi)

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.
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