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Chapter 4. Priority Populations
Many Americans enjoy easy access to one of world's finest health care delivery systems. However, as demonstrated in the 2003 National Healthcare Disparities Report (NHDR), some Americans do not have full access to the best quality health care.
To examine the issue of disparities in health care, Congress directed the Agency for Healthcare Research and Quality (AHRQ) to produce an annual report to track "prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations1." While the emphasis is on disparities related to race, ethnicity, and socioeconomic status (SES), this directive includes a charge to examine disparities in "priority populations"—groups with unique health care needs or issues that require special attention.
This chapter addresses the congressional directive on priority populations. Chapters 2 and 3 of this report examine racial, ethnic, and socioeconomic differences in quality of health care and access to health care in the general U.S. population; this chapter focuses on differences within and across priority populations. For example, comparisons are made between black and white women and between low income and high income women. This approach may help policymakers understand the impact of racial, ethnic, and socioeconomic differences on specific populations and to target quality improvement programs towards groups in greatest need. Appendix D includes detailed tables that allow examination of racial, ethnic, and socioeconomic disparities both in the general population and across priority populations for most measures.
AHRQ's priority populations, specified by Congress in the Healthcare Research and Quality Act of 1999 (Public Law 106-129), are:
- Low income groups
- Minority groups
- Individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care.
In addition, this legislation directs AHRQ to examine health care delivery in rural areas. Hence, this chapter addresses each of these priority populations as well as residents of rural areas.
How This Chapter Is Organized
This chapter presents new information about disparities in quality of and access to health care in priority populations. It is presented in the following order:
- Racial and ethnic minorities
- Low income groups
- Residents of rural areas
- Individuals with special health care needs
To avoid repetition of findings from previous chapters on race, ethnicity, and SES, the first two sections summarize quality of and access to health care for racial and ethnic minorities and low income groups.
Subsequent sections focus on the remaining priority populations and examine disparities in care within each population group. In addition to presenting new data, this chapter goes beyond last year's report by adding changes over time as well as some stratified analyses. To present this greater detail, these sections highlight a small number of measures. Results for all measures are found in the detailed appendix tables.
It should be noted that this chapter does not provide a comprehensive assessment of health care differences in each priority population. Most of the measures tracked in the NHDR were selected to be applicable across many population groups; only a few, such as immunizations among children and screening for breast cancer among women, were specific to particular groups. For some groups, these general measures overlook important health care problems specific to particular populations. In addition, national data may not address key health issues for specific population groups, including persons with disabilities, and are often unable to generate reliable estimates for many smaller groups. Instead, this chapter should be seen as a starting point, identifying some problem areas and indicating gaps in current data and understanding.